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Provider Information for 1427109453

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: 1427109453

Calendar   Last Updated:  2013-11-05
  Certification Date: 


Name Value
NPI 1427109453
Enumeration Date 2007-01-16
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 13110 ELK MOUNTAIN DR
RIVERVIEW, FL 33579-7182
United States

Phone: 813-349-7568 | Fax: 813-349-7561
View Map External Link
Primary Practice Address 14254 MARTIN LUTHER KING BLVD
DOVER, FL 33527-4414
United States

Phone: 813-651-5658 | Fax: 813-349-7861
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
MEDICAID FL 009856200
Primary Taxonomy Selected Taxonomy State License Number
Yes 363LP2300X - Nurse Practitioner Primary Care FL 1329352