1588967673 NPI number — MRS. JULIETTE A SPENCE SEGREE APRN

Table of content: MRS. JULIETTE A SPENCE SEGREE APRN (NPI 1588967673)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588967673 NPI number — MRS. JULIETTE A SPENCE SEGREE APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SEGREE
Provider First Name:
JULIETTE
Provider Middle Name:
A SPENCE
Provider Name Prefix Text:
MRS.
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:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1588967673
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/04/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1324 LAKELAND HILLS BLVD
Provider Second Line Business Mailing Address:
MANAGED CARE DEPT
Provider Business Mailing Address City Name:
LAKELAND
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33805-3203
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
863-687-1100
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1525 LAKELAND HILLS BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKELAND
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33805-3203
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
863-577-2140
Provider Business Practice Location Address Fax Number:
863-413-8518
Provider Enumeration Date:
12/10/2010

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: 363LF0000X , with the licence number:  APRN2001712 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LX0001X , with the licence number: APRN2001712 , 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: 003607400 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com