Healthcare Provider Details

I. General information

NPI: 1144547928
Provider Name (Legal Business Name): SYREETA DRAKE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2010
Last Update Date: 02/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 SE 32ND AVE
OCALA FL
34471-5532
US

IV. Provider business mailing address

1801 SE 32ND AVE
OCALA FL
34471-5532
US

V. Phone/Fax

Practice location:
  • Phone: 352-629-0137
  • Fax: 352-694-4824
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number9303349
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: