Healthcare Provider Details

I. General information

NPI: 1144822701
Provider Name (Legal Business Name): RUNALI TALATI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2020
Last Update Date: 11/09/2020
Certification Date: 11/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39913 SUN GLO CT
LADY LAKE FL
32159-3539
US

IV. Provider business mailing address

39913 SUN GLO CT
LADY LAKE FL
32159-3539
US

V. Phone/Fax

Practice location:
  • Phone: 516-503-6048
  • Fax:
Mailing address:
  • Phone: 516-503-6048
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number11009939
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: