Healthcare Provider Details

I. General information

NPI: 1699536748
Provider Name (Legal Business Name): PAUL A RENTZ ARNP,
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2024
Last Update Date: 01/17/2024
Certification Date: 01/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3543 LITTLE RD STE A
TRINITY FL
34655-1814
US

IV. Provider business mailing address

9341 SACRAMENTO DR
TRINITY FL
34655-1648
US

V. Phone/Fax

Practice location:
  • Phone: 727-848-6400
  • Fax: 727-848-6200
Mailing address:
  • Phone: 727-253-6839
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11029639
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: