MEDICARE: CAMERON ALDER 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	363LG0600X	Gerontology Nurse Practitioner	APRN11010044	FL
2	363LA2200X	Adult Health Nurse Practitioner	APRN11010044	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	:	1609542919
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAMERON ALDER ARNP

Provider Business Mailing Address
First Line	:	5686 OAKWOOD KNOLL DR
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33811-1513
Country	:	US
Telephone Number	:	585-465-8004
Fax Number	:

Provider Business Practice Location Address
First Line	:	700 1ST ST S
Second Line	:
City	:	WINTER HAVEN
State	:	FL
Zip	:	33880-3605
Country	:	US
Telephone Number	:	863-858-8000
Fax Number	:

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

Provider Enumeration Date	:	08/17/2021
Last Update Date	:	08/17/2021

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