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NPI Code Detail

MEDICARE: CHARITY ELEANOR POPP PA-C

MEDICARE: CHARITY ELEANOR POPP PA-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
1363A00000XPhysician AssistantPA 9105392FL

Other Identifiers

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

General Provider Information

NPI Number : 1902109929
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHARITY ELEANOR POPP PA-C
Provider Business Mailing Address
First Line : 4729 US HIGHWAY 98 S STE 201
Second Line :
City : LAKELAND
State : FL
Zip : 33812-4336
Country : US
Telephone Number : 863-646-9663
Fax Number :
Provider Business Practice Location Address
First Line : 4729 US HIGHWAY 98 S STE 201
Second Line :
City : LAKELAND
State : FL
Zip : 33812-4336
Country : US
Telephone Number : 863-646-9663
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/14/2010
Last Update Date : 11/13/2023

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Directions to “ CHARITY ELEANOR POPP PA-C” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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