Healthcare Provider Details

I. General information

NPI: 1376141986
Provider Name (Legal Business Name): EMILY CUNNINGHAM APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2020
Last Update Date: 01/13/2023
Certification Date: 01/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 LAUREL RD E
NORTH VENICE FL
34275-3226
US

IV. Provider business mailing address

PO BOX 947407
ATLANTA GA
30394-7407
US

V. Phone/Fax

Practice location:
  • Phone: 941-262-0400
  • Fax: 941-262-0410
Mailing address:
  • Phone: 941-917-2600
  • Fax: 941-917-7884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11009443
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: