Active NPI
Ursula N Nkwantabisa
- Homemaker
- Fort Walton Beach, FL
National Provider Identifier
1174181754
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Homemaker
- License
- 235901
- Practice address
- 1704 Cartier PL
Fort Walton Beach, FL 32547-5730 - Phone
- (850) 687-7890
- NPI assigned
- May 30, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Homemaker | 376J00000X | 235901 | FL | Primary |
Addresses
Primary practice location
1704 Cartier PL
Fort Walton Beach, FL 32547-5730
Mailing address
1704 Cartier PL
Fort Walton Beach, FL 32547-5730
Phone (850) 687-7890
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| NA | Other | FL | NA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 235901 | FL | MD | Homemaker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Epifani LLC | Homemaker | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1559174400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1559174400000",
"number": "1174181754",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1704 CARTIER PL",
"city": "FORT WALTON BEACH",
"state": "FL",
"postal_code": "325475730",
"telephone_number": "850-687-7890"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1704 CARTIER PL",
"city": "FORT WALTON BEACH",
"state": "FL",
"postal_code": "325475730",
"telephone_number": "850-687-7890"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NKWANTABISA",
"first_name": "URSULA",
"middle_name": "N",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-05-30",
"last_updated": "2019-05-30",
"status": "A"
},
"taxonomies": [
{
"code": "376J00000X",
"taxonomy_group": "",
"desc": "Homemaker",
"state": "FL",
"license": "235901",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NA",
"identifier": "NA",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fort Walton Beach, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.