Provider Demographics
NPI:1326684713
Name:WEAVER, RALPH EDWARD III (ARNP-BC)
Entity Type:Individual
Prefix:
First Name:RALPH
Middle Name:EDWARD
Last Name:WEAVER
Suffix:III
Gender:M
Credentials:ARNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 HICKORY HAMMOCK RD
Mailing Address - Street 2:
Mailing Address - City:LAKE WALES
Mailing Address - State:FL
Mailing Address - Zip Code:33859-7742
Mailing Address - Country:US
Mailing Address - Phone:863-651-3409
Mailing Address - Fax:
Practice Address - Street 1:825 HICKORY HAMMOCK RD
Practice Address - Street 2:
Practice Address - City:LAKE WALES
Practice Address - State:FL
Practice Address - Zip Code:33859-7742
Practice Address - Country:US
Practice Address - Phone:863-651-3409
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-21
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11005164363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily