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NORTH LAKE PRIMARY CARE P.A. NPI 1962809145


NPI Information

NPI: 1962809145
Provider Name: NORTH LAKE PRIMARY CARE, P.A.
Classification: Nurse Practitioner - 363LF0000X
Entity Type: Organization

Specialization: Family

Address:
8022 SAINT JAMES WAY
MOUNT DORA, FL
ZIP 32757
Phone: (352) 516-8931
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NORTH LAKE PRIMARY CARE, P.A. is a family nurse practitioner in Mount Dora, FL. NORTH LAKE PRIMARY CARE, P.A. NPI is 1962809145. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

8022 SAINT JAMES WAY
MOUNT DORA, FL
ZIP 32757-134
Phone: (352) 516-8931

The provider's authorized official is Jeremy E. Creech .
The authorized official title is Proprietor and has the following contact phone number (352) 516-8931.

The enumeration date for this NPI number is 12/3/2014 and was last updated on 12/3/2014.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1363LF0000XNurse PractitionerFamily363L00000XFLORIDAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1009259700MEDICAIDFLORIDA
2HJ008ZMEDICARE UPINFLORIDA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024
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