MEDICARE: ADVANCE PRACTICE PRACTITIONER LLC

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	363L00000X	Nurse Practitioner
2	363A00000X	Physician Assistant

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
2	1932682432	OTHER	FL	NA
3	1952884389	OTHER	FL	NA
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114795721
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCE PRACTICE PRACTITIONER LLC

Provider Business Mailing Address
First Line	:	8526 NEMOURS PKWY
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32827-7752
Country	:	US
Telephone Number	:	954-993-0542
Fax Number	:

Provider Business Practice Location Address
First Line	:	8526 NEMOURS PKWY
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32827-7752
Country	:	US
Telephone Number	:	954-993-0542
Fax Number	:

Authorized Official
Title or Position	:	CEO/PHYSICIAN ASSISTANT
Name	:	MR. ALLISTAIR MCDONALD SMITH
Credential	:
Telephone Number	:	954-993-0542

Provider Enumeration Date	:	12/13/2023
Last Update Date	:	12/13/2023

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Directions to “ADVANCE PRACTICE PRACTITIONER LLC ” Practice Location

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