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General NPI Number Information
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NPI Number | 1063296929
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Entity Type | Organization
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Legal Business Name | ADVANCE NEUROPATHY INSTITUTE LLC
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Dates
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Enumeration Date | 08/22/2023
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Last Update Date | 11/20/2023
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Provider Practice Location Address
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Address Line | 3027 ALOMA AVE
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City | WINTER PARK
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State | FL
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Zip | 32792-3702
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Country | US
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Telephone | 406-813-4784
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Fax |
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Provider Business Mailing Address
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Address Line | 10450 TURKEY LAKE RD UNIT 691232
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City | ORLANDO
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State | FL
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Zip | 32869-7559
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Country | US
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Telephone | 407-624-2844
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Fax |
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | PAMELA WAGENER
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Credential |
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Telephone | 407-624-2844
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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