Provider Demographics
NPI:1578958864
Name:VOGT, ERICA (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:ERICA
Middle Name:
Last Name:VOGT
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MS
Other - First Name:ERICA
Other - Middle Name:ELIZABETH
Other - Last Name:EVEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:83 W MILLER ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-2028
Mailing Address - Country:US
Mailing Address - Phone:321-841-5281
Mailing Address - Fax:407-648-9879
Practice Address - Street 1:83 W MILLER ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-2028
Practice Address - Country:US
Practice Address - Phone:321-841-5281
Practice Address - Fax:407-648-9879
Is Sole Proprietor?:No
Enumeration Date:2015-04-02
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9279027363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL015478900Medicaid
FLARNP9279027OtherMEDICAL LICENSE
FLIG705ZMedicare PIN