Provider Demographics
NPI:1134196702
Name:DERAMO, GREGORY A (ARNP)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:A
Last Name:DERAMO
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5655 S ORANGE AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32809-4289
Mailing Address - Country:US
Mailing Address - Phone:407-895-4100
Mailing Address - Fax:407-438-1543
Practice Address - Street 1:5655 S ORANGE AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32809-4289
Practice Address - Country:US
Practice Address - Phone:407-895-4100
Practice Address - Fax:407-438-1543
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3172462363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
P83037Medicare UPIN