Provider Demographics
NPI:1750317814
Name:APPLEBEE, LARRY ERNEST (PA-C)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:ERNEST
Last Name:APPLEBEE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18550 US HIGHWAY 441
Mailing Address - Street 2:STE A
Mailing Address - City:MOUNT DORA
Mailing Address - State:FL
Mailing Address - Zip Code:32757-6751
Mailing Address - Country:US
Mailing Address - Phone:850-653-1635
Mailing Address - Fax:
Practice Address - Street 1:3256 S PINE AVE
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-6618
Practice Address - Country:US
Practice Address - Phone:352-401-1919
Practice Address - Fax:352-401-1870
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9102669363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL291805600Medicaid
FLU2148ZMedicare ID - Type Unspecified
FLQ10562Medicare UPIN