Active NPI
Magnolia Adult
- Adult Health Nurse Practitioner
- Lake City, FL
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Adult Health Nurse Practitioner
- License
- ARNP3091702
- Legal business name
- MAGNOLIA ADULT
- Practice address
- 1140 SW Bascom Norris Dr Ste 105
Lake City, FL 32025-1329 - Phone
- (386) 755-3300
- Fax
- (386) 755-8595
- NPI assigned
- May 3, 2012
- Last updated
- May 3, 2012
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Ira D Lee, ARNP-C
- Title
- President
- Phone
- (386) 755-3300
Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Adult Health Nurse Practitioner | 363LA2200X | ARNP3091702 | FL | Primary |
Addresses
Primary practice location
1140 SW Bascom Norris Dr Ste 105
Lake City, FL 32025-1329
Mailing address
1140 SW Bascom Norris Dr Ste 105
Lake City, FL 32025-1329
Phone (386) 755-3300
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 305351200 | Medicaid | FL |
National Provider Directory
National Provider Directory- Tax ID family
- Magnolia Adult
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Adult Health Nurse Practitioner
- Lake City, FL
- NPI 1841611407
Locations
1140 SW Bascom Norris Dr
Ste 105
Lake City, FL 32025
Phone (386) 755-3300
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.
-
- Nurse Practitioner
- Lake City, FL
- NPI 1689654584
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1336003200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1336003200000",
"number": "1033477567",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1140 SW BASCOM NORRIS DR STE 105",
"city": "LAKE CITY",
"state": "FL",
"postal_code": "320251329",
"telephone_number": "386-755-3300",
"fax_number": "386-755-8595"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1140 SW BASCOM NORRIS DR STE 105",
"city": "LAKE CITY",
"state": "FL",
"postal_code": "320251329",
"telephone_number": "386-755-3300",
"fax_number": "386-755-8595"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "MAGNOLIA ADULT",
"organizational_subpart": "NO",
"enumeration_date": "2012-05-03",
"last_updated": "2012-05-03",
"status": "A",
"authorized_official_last_name": "LEE",
"authorized_official_first_name": "IRA",
"authorized_official_middle_name": "D",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "386-755-3300",
"authorized_official_credential": "ARNP-C"
},
"taxonomies": [
{
"code": "363LA2200X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Nurse Practitioner, Adult Health",
"state": "FL",
"license": "ARNP3091702",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "305351200",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lake City, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.