Provider Demographics
NPI:1831459585
Name:REAL HEALTH AMERICA, LLC
Entity Type:Organization
Organization Name:REAL HEALTH AMERICA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ARNP/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:BUSA
Authorized Official - Last Name:REALISTA
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:407-616-1111
Mailing Address - Street 1:3251 FALCON POINT DR
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-7547
Mailing Address - Country:US
Mailing Address - Phone:407-616-1111
Mailing Address - Fax:407-297-8409
Practice Address - Street 1:3251 FALCON POINT DR
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-7547
Practice Address - Country:US
Practice Address - Phone:407-616-1111
Practice Address - Fax:407-297-8409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-29
Last Update Date:2012-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9223946363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty