MEDICARE: OTTO R URBAY FNP-C

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	246ZC0007X	Surgical Assistant
2	363LF0000X	Family Nurse Practitioner	APRN11024713	FL

General Provider Information

NPI Number	:	1508247537
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OTTO R URBAY FNP-C

Provider Business Mailing Address
First Line	:	3 MARYLAND FARMS STE 200
Second Line	:
City	:	BRENTWOOD
State	:	TN
Zip	:	37027-5780
Country	:	US
Telephone Number	:	800-348-4565
Fax Number	:	888-203-4247

Provider Business Practice Location Address
First Line	:	2240 W WOOLBRIGHT RD STE 210
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33426-6363
Country	:	US
Telephone Number	:	800-348-4565
Fax Number	:	888-203-4247

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

Provider Enumeration Date	:	06/16/2015
Last Update Date	:	03/02/2023

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