Provider Demographics
NPI:1760625115
Name:SEGREST, M. CELESTE (ARNP)
Entity Type:Individual
Prefix:MS
First Name:M.
Middle Name:CELESTE
Last Name:SEGREST
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:PO BOX 380129
Mailing Address - Street 2:
Mailing Address - City:GRANDIN
Mailing Address - State:FL
Mailing Address - Zip Code:32138-0129
Mailing Address - Country:US
Mailing Address - Phone:386-659-2104
Mailing Address - Fax:386-659-2196
Practice Address - Street 1:1326 SR 100
Practice Address - Street 2:
Practice Address - City:GRANDIN
Practice Address - State:FL
Practice Address - Zip Code:32138-0129
Practice Address - Country:US
Practice Address - Phone:386-659-2104
Practice Address - Fax:386-659-2196
Is Sole Proprietor?:No
Enumeration Date:2009-04-15
Last Update Date:2013-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1020492174400000X
FL1020492363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004724800Medicaid