EHRENTRAUD JOHANNA EICHELBAUM (NPI# 1255518486) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1255518486 |
| Entity Type | Individual |
| Full Name | EHRENTRAUD JOHANNA EICHELBAUM |
| Credential | M.D. |
| Practice Address |
212 S Florida St Bushnell FL 33513-6703 |
| Mailing Address |
1113 Lattimore Dr Clermont FL 34711-9032 |
| Practice Telephone | 3527932441 |
| Practice Fax Number | 3527933282 |
| Mailing Telephone | 9417794869 |
| Enumeration Date | 2008-01-30 |
| Last Update Date | 2019-06-05 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208D00000X | General Practice | ME140028 | FL | Allopathic & Osteopathic Physicians |
| N | 208D00000X | General Practice | 18573 | PR | Allopathic & Osteopathic Physicians |
| N | 246ZS0410X |
Specialist/Technologist, Other Specialization: Surgical Technologist |
238000185 | IL | Technologists, Technicians & Other Technical Service Providers |
| Street Address |
212 S FLORIDA ST |
| City | BUSHNELL |
| State | FL |
| Zip Code | 33513-6703 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467441790 | Vijaya L Nagabhairu | Family Medicine | 212 S Florida St, Bushnell, FL 33513-6703 | 2005-10-19 |
| 1154893477 | Noelle Mooneyham | Nurse Practitioner | 212 S Florida St, Bushnell, FL 33513-6703 | 2018-12-27 |
| 1154804615 | Mary Hyacinth Bodenheimer | Nurse Practitioner | 212 S Florida St, Bushnell, FL 33513-6703 | 2018-09-11 |
| 1669897377 | Ronnie-jane Boekema | Registered Nurse | 212 S Florida St, Bushnell, FL 33513-6703 | 2014-03-04 |
| 1942648803 | Akram Youssef | Family Medicine | 212 S Florida St, Bushnell, FL 33513-6703 | 2013-06-12 |
| 1740531011 | Daniel D Dstteffano | General Practice | 212 S Florida St, Clark Clinic Inc, Bushnell, FL 33513-6703 | 2012-09-27 |
| 1306108022 | Yanira Isbet Lara | Family Medicine | 212 S Florida St, Bushnell, FL 33513-6703 | 2012-06-08 |
| 1992029748 | Victoria A Edelman | Nurse Practitioner | 212 S Florida St, Bushnell, FL 33513-6703 | 2010-03-23 |
| 1376733857 | Clark Clinic Inc | Clinic/Center | 212 S Florida St, Bushnell, FL 33513-6703 | 2007-07-31 |
| 1629278882 | Lowell F. Clark Md Pa | Internal Medicine | 212 S Florida St, Bushnell, FL 33513-6703 | 2007-07-24 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619465481 | Crystal Wallace Goddin | Physical Therapy Assistant | 1104 N Main St, Bushnell, Fl, Bushnell, FL 33513 | 2018-04-27 |
| 1255836920 | Anton Dawson | Behavior Technician | 2310 Cr 615, Bushnell, FL 33513 | 2018-03-26 |
| 1942728431 | Carolyn Sue Guarino | Licensed Practical Nurse | 10306 S.w. 53rd Terr., Bushnell, FL 33513 | 2017-09-05 |
| 1326321258 | Edith Marie Evans | Case Manager/Care Coordinator | 2891 C.r. 615b, Bushnell, FL 33513 | 2011-09-27 |
| 1144478439 | Emma J Ridley | Pharmacist | Sumter Oaks Park, 4602 Couny Rd. 673, #14107, Bushnell, FL 33513 | 2008-08-29 |
| 1205083268 | Diana K Mullin | Day Training, Developmentally Disabled Services | 9325 Cr 622 G, Bushnell, FL 33513 | 2008-08-21 |
| 1467625202 | Amy's Caring Hands | Day Training, Developmentally Disabled Services | 1612 W County Road 476, Bushnell, FL 33513 | 2008-04-11 |
| 1821212952 | Stuart J Kaufman Md & Assoc Pa | Ophthalmology | 1814 West Cr 48, Bushnell, FL 33513 | 2007-04-12 |
| 1740201128 | Winn Dixie Stores Inc | Durable Medical Equipment & Medical Supplies | 1122 N Main St, Bushnell, FL 33513 | 2006-07-21 |
| 1184688947 | Florida Department of Health | Public Health or Welfare | 415 E Noble Ave, Bushnell, FL 33513 | 2006-04-17 |
| Find all providers in zip 33513 | ||||
| Taxonomy Code | 208D00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | General Practice |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235696329 | Carefirst Aco, LLC | General Practice | 1225 W County Road 48, Bushnell, FL 33513-8973 | 2019-02-25 |
| 1063414381 | Angel Gabriel Pagan | General Practice | 117 W Belt Ave, Bushnell, FL 33513-5101 | 2005-06-01 |
| 1740531011 | Daniel D Dstteffano | General Practice | 212 S Florida St, Clark Clinic Inc, Bushnell, FL 33513-6703 | 2012-09-27 |
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| 1992302574 | Avita Medical Clinic, LLC | General Practice | 14831 N Florida Ave, Tampa, FL 33613-1825 | 2020-10-06 |
| 1568069672 | Ernesto Oscar Gonzalez Pupo | General Practice | 14420 Sw 22nd St, Miami, FL 33175-6338 | 2020-10-02 |
| 1508463779 | Ashley Zanders Walton | General Practice | 75 Foxfire Ct, Quincy, FL 32351-7293 | 2020-10-01 |
| 1730796830 | Brid M Wade | General Practice | 3199 Cornell Dr, Gulf Breeze, FL 32563-2785 | 2020-09-23 |
| 1902412786 | New Era Medical Pllc | General Practice | 628 Cleveland St Ste A, Clearwater, FL 33755-6603 | 2020-09-17 |
| 1417562414 | Jl Laria Aprn Pa | General Practice | 5751a Sw 40th St, Miami, FL 33155-5301 | 2020-09-15 |
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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.