Provider Demographics
NPI:1801183397
Name:LEVANTE MEDICAL LLC
Entity Type:Organization
Organization Name:LEVANTE MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:O'HARA
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP-BC
Authorized Official - Phone:352-250-2610
Mailing Address - Street 1:1638 LEESBURG BLVD
Mailing Address - Street 2:
Mailing Address - City:FRUITLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:34731-5215
Mailing Address - Country:US
Mailing Address - Phone:352-326-4269
Mailing Address - Fax:352-326-9266
Practice Address - Street 1:112 S MAIN ST
Practice Address - Street 2:
Practice Address - City:WILDWOOD
Practice Address - State:FL
Practice Address - Zip Code:34785-4539
Practice Address - Country:US
Practice Address - Phone:352-250-2610
Practice Address - Fax:352-326-9266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-05
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2152202363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000360200OtherMEDICAID INDIVIDUAL PROVIDER NUMBER - SEE OTHER #'S DESIGNATED FOR LLC
FL1710186267OtherNPI INDIVIDUAL RENDERING PROVIDER
FLAL386OtherMEDICARE INDIVIDUAL PROVIDER NUMBER - SEE OTHER DESIGNATED #'S FOR LLC