Provider Demographics
NPI:1952658437
Name:ACTIVE OPTIONS LLC
Entity Type:Organization
Organization Name:ACTIVE OPTIONS LLC
Other - Org Name:LLOYDA ROSE-BAXTER, MSN, ANP-BC, RN-BC, CCM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MGMR
Authorized Official - Prefix:
Authorized Official - First Name:LLOYDA
Authorized Official - Middle Name:MAXINE
Authorized Official - Last Name:ROSE-BAXTER
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, ANP- RN-BC, CCM
Authorized Official - Phone:407-765-3130
Mailing Address - Street 1:557 ZINFANDEL CT
Mailing Address - Street 2:
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-5037
Mailing Address - Country:US
Mailing Address - Phone:407-765-3130
Mailing Address - Fax:
Practice Address - Street 1:557 ZINFANDEL CT
Practice Address - Street 2:
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-5037
Practice Address - Country:US
Practice Address - Phone:407-765-3130
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-14
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
163WC0400X
FL163WG0600X
FLARNP9180759363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty
No163WC0400XNursing Service ProvidersRegistered NurseCase ManagementGroup - Multi-Specialty
No163WG0600XNursing Service ProvidersRegistered NurseGerontologyGroup - Multi-Specialty