Provider Demographics
NPI:1518210798
Name:CE MED
Entity Type:Organization
Organization Name:CE MED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTY
Authorized Official - Middle Name:L
Authorized Official - Last Name:EVILSIZOR
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:941-456-8074
Mailing Address - Street 1:209 E TARPON BLVD NW
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-6531
Mailing Address - Country:US
Mailing Address - Phone:941-456-8074
Mailing Address - Fax:
Practice Address - Street 1:209 E TARPON BLVD NW
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-6531
Practice Address - Country:US
Practice Address - Phone:941-456-8074
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-25
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9277675363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Single Specialty