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General NPI Number Information
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NPI Number | 1518210798
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Entity Type | Organization
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Legal Business Name | CE MED
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Dates
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Enumeration Date | 10/25/2012
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Last Update Date | 10/25/2012
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Provider Practice Location Address
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Address Line | 209 E TARPON BLVD NW
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City | PORT CHARLOTTE
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State | FL
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Zip | 33952-6531
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Country | US
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Telephone | 941-456-8074
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Fax |
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Provider Business Mailing Address
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Address Line | 209 E TARPON BLVD NW
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City | PORT CHARLOTTE
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State | FL
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Zip | 33952-6531
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Country | US
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Telephone | 941-456-8074
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | CHRISTY L EVILSIZOR
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Credential | ARNP
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Telephone | 941-456-8074
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | ARNP9277675
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License Number State | FL
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