MEDICARE: MS. SIRIRAT POONTREERATN APRN

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	363LF0000X	Family Nurse Practitioner	APRN11013679	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	:	1316518640
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SIRIRAT POONTREERATN APRN

Provider Business Mailing Address
First Line	:	250 HARRISON ST
Second Line	:
City	:	TITUSVILLE
State	:	FL
Zip	:	32780-5094
Country	:	US
Telephone Number	:	321-268-6868
Fax Number	:

Provider Business Practice Location Address
First Line	:	3701 AVALON PARK WEST BLVD STE 205
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32828-4809
Country	:	US
Telephone Number	:	407-306-0982
Fax Number	:	407-384-7754

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

Provider Enumeration Date	:	07/07/2021
Last Update Date	:	06/14/2023

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