Healthcare Provider Details

I. General information

NPI: 1508482662
Provider Name (Legal Business Name): NWANDO VIVIAN OKARO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2020
Last Update Date: 10/04/2020
Certification Date: 10/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4224 W GULF TO LAKE HWY
LECANTO FL
34461-9215
US

IV. Provider business mailing address

4224 W GULF TO LAKE HWY
LECANTO FL
34461-9215
US

V. Phone/Fax

Practice location:
  • Phone: 352-513-3482
  • Fax:
Mailing address:
  • Phone: 832-292-1483
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11007718
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: