1891703120 NPI number — MS. POON LANH ROLLINSON APRN

Table of content: MS. POON LANH ROLLINSON APRN (NPI 1891703120)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891703120 NPI number — MS. POON LANH ROLLINSON APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROLLINSON
Provider First Name:
POON
Provider Middle Name:
LANH
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
APRN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LANH
Provider Other First Name:
POON
Provider Other Middle Name:
BOPHAPHAL
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
ARNP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1891703120
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/30/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9909 BRIDGETON DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TAMPA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33626-1812
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
850-321-9362
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6928 W LINEBAUGH AVE STE 102
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TAMPA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33625-5803
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-749-7143
Provider Business Practice Location Address Fax Number:
850-644-1578
Provider Enumeration Date:
08/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  ARNP2856762 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 108770600 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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