Provider Demographics
NPI:1508852427
Name:LIVERMORE, MARGARET (ARNP)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:
Last Name:LIVERMORE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:807 S ORLANDO AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-4870
Mailing Address - Country:US
Mailing Address - Phone:407-894-4693
Mailing Address - Fax:407-539-0469
Practice Address - Street 1:4106 W LAKE MARY BLVD
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-3315
Practice Address - Country:US
Practice Address - Phone:407-444-2800
Practice Address - Fax:407-444-2810
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN1232422363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00316552OtherRAILROAD MEDICARE
FLQ38931Medicare UPIN
FLP00316552OtherRAILROAD MEDICARE