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General NPI Number Information
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NPI Number | 1528549490
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Entity Type | Organization
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Legal Business Name | ULTRA HEALTH PROVIDERS OF FLORIDA
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Dates
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Enumeration Date | 08/28/2018
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Last Update Date | 02/11/2025
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Provider Practice Location Address
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Address Line | 701 N WILDER RD
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City | PLANT CITY
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State | FL
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Zip | 33566-7547
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Country | US
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Telephone | 386-562-4899
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 269092 DEPT 1103
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City | OKLAHOMA CITY
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State | OK
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Zip | 73126-9092
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Country | US
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Telephone | 731-394-1145
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | MR. CHARLES R JERMAN III
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Credential |
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Telephone | 731-234-8120
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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