Provider Demographics
NPI:1063654242
Name:FRUM, DOROTHEA DREW (ARNP)
Entity Type:Individual
Prefix:
First Name:DOROTHEA
Middle Name:DREW
Last Name:FRUM
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:DOROTHEA
Other - Middle Name:LYNETTE
Other - Last Name:LEVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1600 SW ARCHER RD
Mailing Address - Street 2:BOX 100109
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32610-0109
Mailing Address - Country:US
Mailing Address - Phone:352-265-1060
Mailing Address - Fax:
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:#100371
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-3003
Practice Address - Country:US
Practice Address - Phone:352-273-5670
Practice Address - Fax:352-273-5683
Is Sole Proprietor?:No
Enumeration Date:2009-04-02
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2051822363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000951900Medicaid
FL000951900Medicaid
BQ674ZMedicare PIN