Individual provider Active NPI

Adriana Haralson, PA-C

  • Physician Assistant
  • Maitland, FL
National Provider Identifier
1245788967
Registry record updated Mar 22, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
500 Winderley PL
Suite 115
Maitland, FL 32751-7247
Phone
(407) 875-0555
Fax
(407) 875-0244
NPI assigned
Sep 12, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 22, 2017

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X Primary

Addresses

Primary practice location

500 Winderley PL
Suite 115
Maitland, FL 32751-7247

Mailing address

2227 Justin Ave
Orlando, FL 32826-4331

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20161101001094 FL Practitioner - Physician Assistant 2062790769 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Sun 'N Lake Medical Group,PA CurrentSince Jan 4, 2021 Accepting new patients
Observation Medicine Specialists LLC Past Accepting new patients

Locations

4958 Sun N Lake Blvd
Ste A
Sebring, FL 33872
Phone (863) 385-8004

4958 Sun N Lake Blvd
Ste B
Sebring, FL 33872
Phone (863) 386-4711

Organizations & group practices 3

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": "1473638400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1490140800000",
    "number": "1245788967",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2227 JUSTIN AVE",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328264331"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 WINDERLEY PL",
            "address_2": "SUITE 115",
            "city": "MAITLAND",
            "state": "FL",
            "postal_code": "327517247",
            "telephone_number": "407-875-0555",
            "fax_number": "407-875-0244"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HARALSON",
        "first_name": "ADRIANA",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-09-12",
        "last_updated": "2017-03-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Maitland, FL

Sources for this page

Verify at the official NPI Registry.