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General NPI Number Information
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NPI Number | 1902612088
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Entity Type | Organization
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Legal Business Name | NEW FORMATIONS CONSULTING LLC
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Dates
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Enumeration Date | 12/04/2024
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Last Update Date | 12/04/2024
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Provider Practice Location Address
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Address Line | 586 MERRITT MORNING WAY APT 2
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City | ALTAMONTE SPRINGS
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State | FL
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Zip | 32701-2872
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Country | US
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Telephone | 843-213-8131
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Fax |
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Provider Business Mailing Address
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Address Line | 586 MERRITT MORNING WAY APT 2
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City | ALTAMONTE SPRINGS
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State | FL
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Zip | 32701-2872
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | PAUL QUALLS
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Credential |
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Telephone | 843-213-8131
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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