Provider Demographics
NPI:1932401387
Name:NINA M. HARE D.O.P.A.
Entity Type:Organization
Organization Name:NINA M. HARE D.O.P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NINA
Authorized Official - Middle Name:MARLENE
Authorized Official - Last Name:HARE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:352-620-2200
Mailing Address - Street 1:2631 SE LAKE WEIR AVE
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-6720
Mailing Address - Country:US
Mailing Address - Phone:352-620-2200
Mailing Address - Fax:352-620-8384
Practice Address - Street 1:2631 SE LAKE WEIR AVE
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-6720
Practice Address - Country:US
Practice Address - Phone:352-620-2200
Practice Address - Fax:352-620-8384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-17
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS 5740261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL061794600Medicaid
FL80278Medicare PIN
FL061794600Medicaid