Provider Demographics
NPI:1750409082
Name:PATTI SPERLING ARNP LLC
Entity type:Organization
Organization Name:PATTI SPERLING ARNP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:WALTER
Authorized Official - Last Name:SPERLING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-544-2207
Mailing Address - Street 1:402 MYRTLEWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-7412
Mailing Address - Country:US
Mailing Address - Phone:910-989-2727
Mailing Address - Fax:910-989-2727
Practice Address - Street 1:402 MYRTLEWOOD CIR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-7412
Practice Address - Country:US
Practice Address - Phone:910-989-2727
Practice Address - Fax:910-989-2727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2010-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
314000000X
FLARNP 9201189363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL306427100Medicaid
FLY078GOtherBC BS
AB718Medicare ID - Type UnspecifiedMEDICARE GROUP # FOR LLC
Q05976Medicare UPIN
FLY078GOtherBC BS