MEDICARE: ADELENE SOTO ARNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0200X	Pediatric Nurse Practitioner	ARNP9229185	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003049990
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADELENE SOTO ARNP

Provider Business Mailing Address
First Line	:	3372 TUMBLING RIVER DR
Second Line	:
City	:	CLERMONT
State	:	FL
Zip	:	34711-8907
Country	:	US
Telephone Number	:	407-467-5947
Fax Number	:

Provider Business Practice Location Address
First Line	:	930 MARCUM RD
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33809-4308
Country	:	US
Telephone Number	:	863-815-3775
Fax Number	:	863-815-3765

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/26/2009
Last Update Date	:	11/17/2009

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