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General NPI Number Information
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NPI Number | 1124491402
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Entity Type | Individual
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Provider Name | KHALID AQUIL
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Gender | Male
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Dates
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Enumeration Date | 11/09/2015
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Last Update Date | 01/15/2016
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Provider Practice Location Address
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Address Line | 2336 CLEVELAND AVE STE B
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City | FORT MYERS
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State | FL
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Zip | 33901-3540
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Country | US
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Telephone | 239-332-0407
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Fax |
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Provider Business Mailing Address
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Address Line | 6900 DANIELS PKWY STE 29-118
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City | FORT MYERS
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State | FL
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Zip | 33912-7513
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | ARNP9286941
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License Number State | FL
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