Healthcare Provider Details

I. General information

NPI: 1992258164
Provider Name (Legal Business Name): ARTHUR KHARONOV
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2016
Last Update Date: 12/30/2025
Certification Date: 12/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1208 BOWMAN ST
CLERMONT FL
34711-3144
US

IV. Provider business mailing address

109 AMBERSWEET WAY STE 642
DAVENPORT FL
33897-8418
US

V. Phone/Fax

Practice location:
  • Phone: 732-599-0690
  • Fax:
Mailing address:
  • Phone: 732-599-0690
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11006992
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF340565
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ00675300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: