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General NPI Number Information
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NPI Number | 1962809145
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Entity Type | Organization
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Legal Business Name | NORTH LAKE PRIMARY CARE, P.A.
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Dates
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Enumeration Date | 12/03/2014
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Last Update Date | 12/03/2014
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Provider Practice Location Address
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Address Line | 8022 SAINT JAMES WAY
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City | MOUNT DORA
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State | FL
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Zip | 32757-9134
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Country | US
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Telephone | 352-516-8931
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Fax |
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Provider Business Mailing Address
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Address Line | 8022 SAINT JAMES WAY
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City | MOUNT DORA
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State | FL
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Zip | 32757-9134
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Country | US
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Telephone | 352-516-8931
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Fax |
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Authorized Official
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Title or Position | PROPRIETOR
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Name | MR. JEREMY E. CREECH
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Credential | ARNP
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Telephone | 352-516-8931
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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 | 363L00000X
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License Number State | FL
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