Healthcare Provider Details

I. General information

NPI: 1174945190
Provider Name (Legal Business Name): NEUROHEALTH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2014
Last Update Date: 03/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2685 SW 32ND PL SUITE 100
OCALA FL
34471-7862
US

IV. Provider business mailing address

2685 SW 32ND PL SUITE 100
OCALA FL
34471-7862
US

V. Phone/Fax

Practice location:
  • Phone: 352-732-9643
  • Fax: 352-732-2243
Mailing address:
  • Phone: 352-732-9643
  • Fax: 352-732-2243

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberME42777
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA2229
License Number StateFL

VIII. Authorized Official

Name: NICOLE LOCKHART
Title or Position: ADMINISTRATOR
Credential:
Phone: 352-732-9643