LARGO WELLNESS PRIMARY CARE (NPI# 1245759596) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1245759596 |
| Entity Type | Organization |
| Organization Name | LARGO WELLNESS PRIMARY CARE |
| Practice Address |
415 7th Ave Sw Largo FL 33770-3400 |
| Practice Telephone | 7275011040 |
| Enumeration Date | 2017-09-18 |
| Last Update Date | 2018-09-26 |
| NPI Deactivation Date | 08/15/2018 |
| NPI Reactivation Date | 2018-09-26 |
| Authorized Official Name | MICKORIA SMITH (CHIEF OPERATING OFFICER) |
| Authorized Official Telephone | 5614207501 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LP2300X |
Nurse Practitioner Specialization: Primary Care |
Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
415 7TH AVE SW |
| City | LARGO |
| State | FL |
| Zip Code | 33770-3400 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467005041 | Chelsey Lyn Shepos | Optometrist | 1030 West Bay Dr, Suite 200, Largo, FL 33770 | 2019-07-22 |
| 1407353626 | Michael E Ibrahim | Pharmacist | 1290 West Bay Drive, Largo, FL 33770 | 2018-04-13 |
| 1518413384 | Payton Kuhlenbeck | Anesthesiology | 210 14th Street Sw, Largo, FL 33770 | 2016-08-31 |
| 1639536865 | Ryan Boice | Physical Therapy Assistant | 118 West Bay Drive, Suite 111, Largo, FL 33770 | 2016-01-19 |
| 1508238858 | Alignment Healthcare Florida LLC | Clinic/Center | 1301 2nd Ave., Sw, Largo, FL 33770 | 2015-10-27 |
| 1891161808 | Jessica Nicole Mcglone | Nurse Practitioner | 601 Rosery Rd Ne Apt 1502, Largo, FL 33770 | 2015-08-12 |
| 1033598602 | Demetria Anderson | Counselor | 1301 Seminole Blvd Ste 103, Largo, FL 33770 | 2015-05-28 |
| 1962881821 | Building Blocks Therapy, Pllc | Community/Behavioral Health | 1301 Seminole Blvd Building A Suite 103, Largo, FL 33770 | 2015-05-26 |
| 1457765968 | Summer Moon | Dermatology | 115 Highland Ave N, Largo, FL 33770 | 2014-06-12 |
| 1578982393 | Lauren Elizabeth Grandpre | Emergency Medicine | 201 14th St. Sw, Largo Medical Center Emergency Department, Largo, FL 33770 | 2014-04-09 |
| Find all providers in zip 33770 | ||||
| Taxonomy Code | 363LP2300X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Primary Care |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174986038 | Olga Emilia Martinez Bohan | Nurse Practitioner | 12685 Starkey Rd, Largo, FL 33773-1421 | 2016-03-29 |
| 1255962510 | Adetola O Oyekan | Nurse Practitioner | 1400 Mercantile Ln Ste 180, Largo, MD 20774-5369 | 2020-01-27 |
| 1093283145 | Patricia Hanratty | Nurse Practitioner | 1301 2nd Ave Sw, Largo, FL 33770-2298 | 2018-11-07 |
| 1154846442 | Nathan Moore | Nurse Practitioner | 12899 Walsingham Rd, Largo, FL 33774-3537 | 2017-08-08 |
| 1538578927 | Alexsandra De Oliveira | Nurse Practitioner | 7241 Bryan Dairy Rd, Largo, FL 33777-1538 | 2014-08-11 |
| 1407293350 | Peggy Ann St Croix | Nurse Practitioner | 1301 2nd Ave Sw, Largo, FL 33770 | 2013-06-03 |
| 1215964168 | Joanne Ruth Talarico | Nurse Practitioner | 1301 2nd Ave Sw, Largo, FL 33770-3120 | 2006-06-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649871724 | Brenna Schulman | Nurse Practitioner | 6859 Sw 18th St Ste 200, Boca Raton, FL 33433-7015 | 2020-11-04 |
| 1245831726 | Sydia Spence | Nurse Practitioner | 8001 Nw 66th Ter, Tamarac, FL 33321-7015 | 2020-11-02 |
| 1598365165 | Fernande Simeon | Nurse Practitioner | 6490 Nw 55th St, Coral Springs, FL 33067-2710 | 2020-10-31 |
| 1780284596 | Corrective Spinal Care Inc | Nurse Practitioner | 6965 Piazza Grande Ave Ste 207, Orlando, FL 32835-8780 | 2020-10-30 |
| 1023617420 | John Bertram Garrett Iv | Nurse Practitioner | 5079 Garrett Rd, Malone, FL 32445-3409 | 2020-10-19 |
| 1518565894 | Karen Giselle Reyes | Nurse Practitioner | 4563 Perth Rd, West Palm Beach, FL 33415-2811 | 2020-10-09 |
| 1265039424 | Catherine Dettelbach Lake | Nurse Practitioner | 3411 Shenandoah Dr W, Orange Park, FL 32073-6631 | 2020-10-01 |
| 1417562877 | Victoria Ann Jacobs | Nurse Practitioner | 3605 Lithia Ridge Blvd, Valrico, FL 33596-6482 | 2020-09-12 |
| 1760096135 | Conciergenp | Nurse Practitioner | 1221 S 23rd Ave, Hollywood, FL 33020-5912 | 2020-09-03 |
| 1649881434 | Dr Jose A Rivera LLC | Nurse Practitioner | 110 W Citrus St, Altamonte Springs, FL 32714-2502 | 2020-08-14 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.