Healthcare Provider Details

I. General information

NPI: 1154159937
Provider Name (Legal Business Name): EMILY CIPPONERI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2024
Last Update Date: 09/16/2024
Certification Date: 09/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD
GAINESVILLE FL
32610-3008
US

IV. Provider business mailing address

13703 NW 9TH RD
NEWBERRY FL
32669-8038
US

V. Phone/Fax

Practice location:
  • Phone: 352-273-6815
  • Fax:
Mailing address:
  • Phone: 586-863-3149
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number9488748
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11034326
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN11034326
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: