Organization
LEVANTE MEDICAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DONNA JEAN O'HARA ARNP-BC (OWNER)
(352) 250-2610
Entity
Organization
Contact information
Practice address
112 S MAIN ST, WILDWOOD, FL 34785-4539
(352) 250-2610
(352) 326-9266
Mailing address
1638 LEESBURG BLVD, FRUITLAND PARK, FL 34731-5215
(352) 326-4269
(352) 326-9266
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
ARNP2152202
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000360200
MEDICAID INDIVIDUAL PROVIDER NUMBER - SEE OTHER #'S DESIGNATED FOR LLC
FL
01
—
1710186267
NPI INDIVIDUAL RENDERING PROVIDER
FL
01
—
AL386
MEDICARE INDIVIDUAL PROVIDER NUMBER - SEE OTHER DESIGNATED #'S FOR LLC
FL
Enumeration date
07/05/2011
Last updated
08/29/2011
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