Provider Demographics
NPI:1073985537
Name:ARMELLE G CLEOPHAT PHD ARNP-BC
Entity Type:Organization
Organization Name:ARMELLE G CLEOPHAT PHD ARNP-BC
Other - Org Name:MOBILE MEDICAL HEALTH SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ARMELLE
Authorized Official - Middle Name:GUITEAU
Authorized Official - Last Name:OSIAS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:352-286-6553
Mailing Address - Street 1:21840 SW 1ST ST
Mailing Address - Street 2:
Mailing Address - City:DUNNELLON
Mailing Address - State:FL
Mailing Address - Zip Code:34431-1641
Mailing Address - Country:US
Mailing Address - Phone:352-286-6553
Mailing Address - Fax:352-559-0587
Practice Address - Street 1:21840 SW 1ST ST
Practice Address - Street 2:
Practice Address - City:DUNNELLON
Practice Address - State:FL
Practice Address - Zip Code:34431-1641
Practice Address - Country:US
Practice Address - Phone:352-286-6553
Practice Address - Fax:352-559-0587
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-23
Last Update Date:2019-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9215818261QP2300X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLIJ177AMedicare PIN
FL1154311868OtherNPI
FL307408100Medicaid