Provider Demographics
NPI:1881464683
Name:ADVANCED HEALTH PRACTICE SOLUTIONS INC
Entity type:Organization
Organization Name:ADVANCED HEALTH PRACTICE SOLUTIONS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:BETHSAIDA
Authorized Official - Middle Name:LOPEZ
Authorized Official - Last Name:GILLUM
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:850-728-6503
Mailing Address - Street 1:3554 LAKESHORE DR
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32312-1487
Mailing Address - Country:US
Mailing Address - Phone:850-728-6503
Mailing Address - Fax:
Practice Address - Street 1:333 N BYRON BUTLER PKWY
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:FL
Practice Address - Zip Code:32347-2300
Practice Address - Country:US
Practice Address - Phone:850-584-0800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-03
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty