Provider Demographics
NPI:1023332848
Name:RESTREPO, GERMAN (ANP)
Entity type:Individual
Prefix:
First Name:GERMAN
Middle Name:
Last Name:RESTREPO
Suffix:
Gender:M
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 ELM ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940-6132
Mailing Address - Country:US
Mailing Address - Phone:845-344-1102
Mailing Address - Fax:
Practice Address - Street 1:250 N ALAFAYA TRL STE 100
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-4316
Practice Address - Country:US
Practice Address - Phone:407-282-4400
Practice Address - Fax:407-282-4191
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-23
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY595740163W00000X
NYF308343363LA2200X
FLAPRN11016567363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY05027761Medicaid
NYF308343OtherANP LICENSE