Provider Demographics
NPI:1376730796
Name:ADVANCED PRACTITIONERS
Entity Type:Organization
Organization Name:ADVANCED PRACTITIONERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:A.R.N.P.
Authorized Official - Prefix:MS
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:REGINA
Authorized Official - Last Name:GALDA
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:352-346-5949
Mailing Address - Street 1:PO BOX 36
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34605-0036
Mailing Address - Country:US
Mailing Address - Phone:352-346-5949
Mailing Address - Fax:352-848-3058
Practice Address - Street 1:26 E LIBERTY ST
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34601-2910
Practice Address - Country:US
Practice Address - Phone:352-848-3068
Practice Address - Fax:352-848-3058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-30
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL302677900Medicaid
FLK2366Medicare PIN
FLS65553Medicare UPIN