Provider Demographics
NPI:1205845682
Name:HANDBERG, EILEEN M (ARNP)
Entity type:Individual
Prefix:MS
First Name:EILEEN
Middle Name:M
Last Name:HANDBERG
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:EILEEN
Other - Middle Name:MARY
Other - Last Name:HANDBERG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 918025
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32891-8025
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-3003
Practice Address - Country:US
Practice Address - Phone:352-846-0612
Practice Address - Fax:352-846-3451
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1230412363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
S74123Medicare UPIN
FLE2141ZMedicare PIN