=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134272628
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARIA ROSARIO PAGAN APNC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/19/2007
-----------------------------------------------------
Last Update Date | 09/06/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 821 OAKLEY SEAVER DR
-----------------------------------------------------
City | CLERMONT
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34711-1968
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-242-1665
-----------------------------------------------------
Fax | 352-243-1649
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 821 OAKLEY SEAVER DR
-----------------------------------------------------
City | CLERMONT
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34711-1968
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-703-0784
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | 26NO10472200
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | APRN11023455
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------