1306960190 NPI number — AMY W REGISTER CNP

Table of content: AMY W REGISTER CNP (NPI 1306960190)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306960190 NPI number — AMY W REGISTER CNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REGISTER
Provider First Name:
AMY
Provider Middle Name:
W
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WINANS
Provider Other First Name:
AMY
Provider Other Middle Name:
W
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1306960190
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/05/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1070 MONTGOMERY RD UNIT 556
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALTAMONTE SPRINGS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32714-7420
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
941-841-6528
Provider Business Mailing Address Fax Number:
407-602-0957

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8051 N TAMIAMI TRL STE E6
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SARASOTA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34243-2067
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
941-841-6528
Provider Business Practice Location Address Fax Number:
407-602-0957
Provider Enumeration Date:
03/19/2007

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:  ARNP9323179 , 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: 014876000 . 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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