Provider Demographics
NPI:1275108953
Name:PRAKASH, PRANAV (MD)
Entity Type:Individual
Prefix:MR
First Name:PRANAV
Middle Name:
Last Name:PRAKASH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1147 NW 64TH TERRACE
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605
Mailing Address - Country:US
Mailing Address - Phone:352-333-5173
Mailing Address - Fax:352-331-9562
Practice Address - Street 1:7485 SW 17TH ROAD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32607
Practice Address - Country:US
Practice Address - Phone:352-333-5700
Practice Address - Fax:352-376-4975
Is Sole Proprietor?:No
Enumeration Date:2021-05-25
Last Update Date:2023-02-07
Deactivation Date:2022-11-14
Deactivation Code:
Reactivation Date:2023-02-07
Provider Licenses
StateLicense IDTaxonomies
FL390200000X
FLTRN33916390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program