Facts
- Status
- A
- Credential
- APRN
- Type
- Individual
- Enumeration date
- 2019-05-30
- Last updated
- 2021-11-12
Licenses
- License FL
- APRN11002563
- License FL
- APRN11002563
Location
- Practice location
- 16939 SW 134TH AVE
- City
- ARCHER FL
- Postal code
- 326185413
- Phone
- 352-265-2550
Medicare
- PECOS
- A PECOS enrollment row matches this NPI.
LEIE
The OIG NPI list is not in this build yet. Confirm on OIG's search.
Nearby
Search this city from the state hub for other records in the public registry.
Removal request
Public data from NPPES and CMS. Not a credentialing determination.