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Provider Information for 1083121669

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know


Gender: FEMALE

Individual NPI: 1083121669

Calendar   Last Updated:  2018-01-04
  Certification Date: 


Name Value
NPI 1083121669
Enumeration Date 2018-01-04
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 6089 SE 118TH PL
BELLEVIEW, FL 34420-5249
United States

Phone: | Fax:
View Map External Link
Primary Practice Address 1400 N US HIGHWAY 441 STE 552
THE VILLAGES, FL 32159-8987
United States

Phone: 352-751-2862 | Fax:
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Primary Taxonomy Selected Taxonomy State License Number
Yes 363L00000X - Nurse Practitioner FL ARNP9360971