1801566583 NPI number — PREMISE HEALTH OF FLORIDA MEDICAL, P.A.

Table of content: APRIL DAWN OTTANI MS, BCBA (NPI 1821549320)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801566583 NPI number — PREMISE HEALTH OF FLORIDA MEDICAL, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PREMISE HEALTH OF FLORIDA MEDICAL, P.A.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1801566583
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/31/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5500 MARYLAND WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRENTWOOD
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37027-7048
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5201 GATE PKWY RM 134
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JACKSONVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32256-7284
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-645-4060
Provider Business Practice Location Address Fax Number:
904-645-4061
Provider Enumeration Date:
09/15/2021

Additional Information

Authorized Official

Authorized Official Last Name:
WRIGHT
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
Authorized Official Title or Position:
LEGAL COUNSEL
Authorized Official Telephone Number:
615-577-5893

Provider Taxonomy Codes

  • Taxonomy code: 261QM1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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