Juliet Omonme Agbator, APRN
Individual provider Active NPI Family Nurse Practitioner · Orange City, FL
NPI 1023768942 · NPPES record last updated Mar 24, 2022
Key facts
- NPI
- 1023768942
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 11017367 (FL)
- Practice address
- 955 Town Center Dr Ste 100
Orange City, FL 32763-8255 - Phone
- (386) 228-0661
- NPI assigned
- Mar 24, 2022
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in FL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20221116000057 | FL | Practitioner - Nurse Practitioner | 8729456124 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11017367 | FL | MD | Family Nurse Practitioner |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 11017367 | FL | Yes |
Addresses
Primary practice location
955 Town Center Dr Ste 100
Orange City, FL 32763-8255
Mailing address
308 Casa Marina PL
Sanford, FL 32771-5228
Phone (407) 687-3430
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| SOAP URL | SOAP | Health Information Exchange (HIE) |
Other providers in Orange City, FL
- Advanced Practice and Wellness LLC
- Advanced Prosthetics of America Inc
- Advanced Urology Institute LLC
- Advantage Medical Group LLC
- Adventist Health System/Sunbelt, Inc.
- Damaris Age
- Faisal Ahmad
- Uzma Ahmed Khurshid
- Kaleem Ahmed
- Shazia Ahmed
All providers in Orange City, FL · Family Nurse Practitioner in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 24, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.