Healthcare Provider Details

I. General information

NPI: 1508467374
Provider Name (Legal Business Name): ANTHONY ARIAS BRAVO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2020
Last Update Date: 01/17/2026
Certification Date: 01/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6644 SW 81ST LOOP
OCALA FL
34476-4540
US

IV. Provider business mailing address

6644 SW 81ST LOOP
OCALA FL
34476-4540
US

V. Phone/Fax

Practice location:
  • Phone: 646-331-4792
  • Fax:
Mailing address:
  • Phone: 646-331-4792
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number815105
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF353756-01
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number17-674
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11025573
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number9570547
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: