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General NPI Number Information
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NPI Number | 1801183397
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Entity Type | Organization
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Legal Business Name | LEVANTE MEDICAL LLC
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Dates
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Enumeration Date | 07/05/2011
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Last Update Date | 08/29/2011
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Provider Practice Location Address
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Address Line | 112 S MAIN ST
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City | WILDWOOD
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State | FL
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Zip | 34785-4539
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Country | US
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Telephone | 352-250-2610
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Fax | 352-326-9266
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Provider Business Mailing Address
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Address Line | 1638 LEESBURG BLVD
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City | FRUITLAND PARK
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State | FL
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Zip | 34731-5215
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Country | US
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Telephone | 352-326-4269
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Fax | 352-326-9266
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Authorized Official
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Title or Position | OWNER
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Name | DONNA JEAN O'HARA
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Credential | ARNP-BC
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Telephone | 352-250-2610
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | ARNP2152202
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License Number State | FL
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