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Provider Information for 1417331273

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: 1417331273

Calendar   Last Updated:  2019-04-16
  Certification Date: 


Name Value
NPI 1417331273
Enumeration Date 2015-07-11
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 3600 OAK MANOR LN. #46
LARGO, FL 33774
United States

Phone: 727-504-2792 | Fax: 727-499-9559
View Map External Link
Primary Practice Address 3600 OAK MANOR LN APT 46
LARGO, FL 33774-1214
United States

Phone: 727-489-3305 | Fax: 727-499-9559
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 ARNP9308838