Provider Demographics
NPI:1912228495
Name:WELCH, JOHN PAUL (ANP-BC, RN)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:PAUL
Last Name:WELCH
Suffix:
Gender:M
Credentials:ANP-BC, RN
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Mailing Address - Street 1:490 CENTRE LAKE DR NE STE 200B
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32907-1189
Mailing Address - Country:US
Mailing Address - Phone:321-784-8211
Mailing Address - Fax:321-394-9425
Practice Address - Street 1:2113 SARNO RD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-3001
Practice Address - Country:US
Practice Address - Phone:321-676-0558
Practice Address - Fax:321-622-3588
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-18
Last Update Date:2023-05-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLARNP9219350363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLARNP 9219350OtherSTATE LICENSE NUMBER
FLDI487VMedicare UPIN