Healthcare Provider Details

I. General information

NPI: 1316967755
Provider Name (Legal Business Name): MICHAEL D BUMBACH ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 01/26/2023
Certification Date: 01/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 NE 25TH AVE SUITE 302
OCALA FL
34470-5675
US

IV. Provider business mailing address

PO BOX 117500
GAINESVILLE FL
32611-7500
US

V. Phone/Fax

Practice location:
  • Phone: 352-622-2221
  • Fax: 352-622-4193
Mailing address:
  • Phone: 352-392-1161
  • Fax: 352-392-9625

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN9258948
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARNP 9258948
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: