1922272459 NPI number — MS. KERRI MARIE VARNEY ARNP-C

Table of content: MS. KERRI MARIE VARNEY ARNP-C (NPI 1922272459)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922272459 NPI number — MS. KERRI MARIE VARNEY ARNP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VARNEY
Provider First Name:
KERRI
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
ARNP-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TREMBLAY
Provider Other First Name:
KERRI
Provider Other Middle Name:
MARIE
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:
1922272459
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/31/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1680 SE LYNGATE DR STE 204
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORT SAINT LUCIE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34952-4300
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
772-222-5411
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1796 US HIGHWAY 441 N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OKEECHOBEE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34972-1918
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
863-763-2151
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/16/2008

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:  ARNP3290212 , 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: 001651100 . 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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