Healthcare Provider Details

I. General information

NPI: 1225946494
Provider Name (Legal Business Name): MILDRED LORRAINE BARTLEY APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2105 SW 20TH PL
OCALA FL
34471-7734
US

IV. Provider business mailing address

1514 MOSS AVE
LEESBURG FL
34748-3114
US

V. Phone/Fax

Practice location:
  • Phone: 352-622-4251
  • Fax:
Mailing address:
  • Phone: 574-527-6627
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number11050489
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: