Provider Demographics
NPI:1841861366
Name:PORTER, JAMES R
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:R
Last Name:PORTER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 SW 24TH AVE APT 604
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-7822
Mailing Address - Country:US
Mailing Address - Phone:606-264-1413
Mailing Address - Fax:
Practice Address - Street 1:3001 SW 24TH AVE APT 604
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-7822
Practice Address - Country:US
Practice Address - Phone:606-264-1413
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-06
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11023743363LP0808X
KY3016319363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health