Provider Demographics
NPI:1326030537
Name:POLLARD, JOHN R (ARNP)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:R
Last Name:POLLARD
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1312
Mailing Address - Street 2:
Mailing Address - City:MULBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:33860-1312
Mailing Address - Country:US
Mailing Address - Phone:863-619-5201
Mailing Address - Fax:863-646-8575
Practice Address - Street 1:1310 N CHURCH AVE
Practice Address - Street 2:
Practice Address - City:MULBERRY
Practice Address - State:FL
Practice Address - Zip Code:33860-2047
Practice Address - Country:US
Practice Address - Phone:863-619-5201
Practice Address - Fax:863-646-8575
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1827122363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP08543Medicare UPIN
FLY86718Medicare ID - Type Unspecified