Generationspan Healthcare LLC

Primary specialty

Gerontology Nurse PractitionerTaxonomy code 363LG0600X

License

3314182 Issued in FL

Legal business name

GENERATIONSPAN HEALTHCARE LLC

Practice address

400 Capital Cir SE Ste 18128
Tallahassee, FL 32301-3802

Phone

(850) 264-9070

NPI assigned

Nov 21, 2013

Last updated

Nov 21, 2013By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ms. Florence Pedatin Bamgbose, PHD ARNPNPI 1720051840

Title

Ceo

Phone

(850) 264-9070

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Locations

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.

• Florence P Bamgbose, ARNP

  • Gerontology Nurse Practitioner
  • Tallahassee, FL
  • NPI 1720051840
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1384992000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1384992000000",
    "number": "1275963662",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6271 WILLIAMS RD",
            "city": "TALLAHASSEE",
            "state": "FL",
            "postal_code": "323118526",
            "telephone_number": "850-264-9070"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 CAPITAL CIR SE STE 18128",
            "city": "TALLAHASSEE",
            "state": "FL",
            "postal_code": "323013802",
            "telephone_number": "850-264-9070"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GENERATIONSPAN HEALTHCARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-11-21",
        "last_updated": "2013-11-21",
        "status": "A",
        "authorized_official_last_name": "BAMGBOSE",
        "authorized_official_first_name": "FLORENCE",
        "authorized_official_middle_name": "PEDATIN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "850-264-9070",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "PHD ARNP"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "FL",
            "license": "3314182",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "305043200",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Genoa Healthcare LLC
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• Gerontology Nurse Practitioner in Tallahassee, FL
• Providers in Tallahassee, FL by specialty
• Gerontology Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.