Healthcare Provider Details

I. General information

NPI: 1740479096
Provider Name (Legal Business Name): NORTH POINT PHYSICIANS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2007
Last Update Date: 05/04/2022
Certification Date: 05/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1395 N COURTENAY PKWY SUITE 107
MERRITT ISLAND FL
32953-4400
US

IV. Provider business mailing address

1395 N COURTENAY PKWY SUITE 107
MERRITT ISLAND FL
32953-4400
US

V. Phone/Fax

Practice location:
  • Phone: 321-453-1955
  • Fax: 321-454-2406
Mailing address:
  • Phone: 321-453-1955
  • Fax: 321-454-2406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS7484
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberOS9648
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARNP1657502
License Number StateFL

VIII. Authorized Official

Name: MARLO LUCIANI
Title or Position: OFFICE MANAGER
Credential:
Phone: 321-453-1955