Healthcare Provider Details

I. General information

NPI: 1952494924
Provider Name (Legal Business Name): EMILIE RAE LANG ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 03/04/2020
Certification Date: 03/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1034 NW 57TH ST
GAINESVILLE FL
32605-4482
US

IV. Provider business mailing address

5023 NW 16TH PL
GAINESVILLE FL
32605-3413
US

V. Phone/Fax

Practice location:
  • Phone: 352-519-5430
  • Fax:
Mailing address:
  • Phone: 352-222-6225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9190070
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: