Healthcare Provider Details

I. General information

NPI: 1093169864
Provider Name (Legal Business Name): MEDICAL MANAGEMENT OF OCALA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2016
Last Update Date: 04/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2120 SW 22ND PL
OCALA FL
34471-7765
US

IV. Provider business mailing address

2120 SW 22ND PL
OCALA FL
34471-7765
US

V. Phone/Fax

Practice location:
  • Phone: 352-732-5042
  • Fax: 352-732-6031
Mailing address:
  • Phone: 352-732-5042
  • Fax: 352-732-6031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9319416
License Number StateFL

VIII. Authorized Official

Name: MR. WILLIAM E BALD
Title or Position: PRESIDENT
Credential:
Phone: 352-732-5042