Healthcare Provider Details

I. General information

NPI: 1063296929
Provider Name (Legal Business Name): ADVANCE NEUROPATHY INSTITUTE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2023
Last Update Date: 11/20/2023
Certification Date: 11/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3027 ALOMA AVE
WINTER PARK FL
32792-3702
US

IV. Provider business mailing address

10450 TURKEY LAKE RD UNIT 691232
ORLANDO FL
32869-7559
US

V. Phone/Fax

Practice location:
  • Phone: 406-813-4784
  • Fax:
Mailing address:
  • Phone: 407-624-2844
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: PAMELA WAGENER
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 407-624-2844