A1 Medical & Behavioral Health LLC
Organization Active NPI Adult Health Nurse Practitioner · St Petersburg, FL
NPI 1689119174 · NPPES record last updated Jan 9, 2017
Key facts
- NPI
- 1689119174
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Adult Health Nurse Practitioner 363LA2200X
- Legal business name
- A1 MEDICAL & BEHAVIORAL HEALTH LLC
- Practice address
- 2822 54TH Ave S # 215
Suite 215
St Petersburg, FL 33712-4610 - Phone
- (727) 218-8961
- NPI assigned
- Dec 20, 2016
- Organization subpart
- No
Authorized official
- Name
- Ms. Angela Denise Harvey
- Title
- Arnp
- Phone
- (727) 218-8961
Practitioners 1
-
Angela D Harvey, ARNP-C
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in FL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20170306000942 | FL | Part B Supplier - Clinic/Group Practice | 1557645835 |
Receives reassigned benefits from 1 practitioner Practice locations: St Petersburg, FL |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Adult Health Nurse Practitioner |
363LA2200X | Yes | ||
| Gerontology Nurse Practitioner |
363LG0600X | |||
| Psychiatric/Mental Health Nurse Practitioner |
363LP0808X |
Addresses
Primary practice location
2822 54TH Ave S # 215
Suite 215
St Petersburg, FL 33712-4610
Mailing address
2822 54TH Ave S # 215
Suite 215
St Petersburg, FL 33712-4610
Phone (727) 218-8961
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- Aaron J Smith & Sophia Kibuismith
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All providers in St Petersburg, FL · Adult Health 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 Jan 9, 2017. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.