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General NPI Number Information
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NPI Number | 1578265443
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Entity Type | Individual
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Provider Name | TINA M PAGAN
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Gender | Female
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Dates
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Enumeration Date | 03/21/2023
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Last Update Date | 03/21/2023
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Provider Practice Location Address
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Address Line | 685 PALM SPRINGS DR STE 2A
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City | ALTAMONTE SPRINGS
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State | FL
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Zip | 32701-7853
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Country | US
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Telephone | 407-830-5577
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Fax |
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Provider Business Mailing Address
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Address Line | 12808 GETTYSBURG CIR
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City | ORLANDO
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State | FL
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Zip | 32837-5015
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Country | US
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Telephone | 407-697-7517
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 11011909
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License Number State | FL
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