Healthcare Provider Details

I. General information

NPI: 1003708249
Provider Name (Legal Business Name): EFROSINI XANTHOUDAKIS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2025
Last Update Date: 07/21/2025
Certification Date: 07/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 OSPREY BLVD
BARTOW FL
33830-3308
US

IV. Provider business mailing address

4315 HIGHLAND PARK BLVD STE A
LAKELAND FL
33813-1639
US

V. Phone/Fax

Practice location:
  • Phone: 863-533-8111
  • Fax:
Mailing address:
  • Phone: 863-816-5884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number11041066
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: