Active NPI
Audrey Vanetten-Runte, PHARMD, PA-C
- Pharmacist
- Middleburg, FL
National Provider Identifier
1912188657
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PS33649
- Practice address
- 430 College Dr
Suites 100, 102, 104
Middleburg, FL 32068-8530 - Phone
- (904) 730-5774
- NPI assigned
- Nov 23, 2007
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA9104243 | FL | |
| Pharmacist | 183500000X | PS33649 | FL | Primary |
Addresses
Primary practice location
430 College Dr
Suites 100, 102, 104
Middleburg, FL 32068-8530
Mailing address
PO Box 66087
Orange Park, FL 32065-0019
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
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PS33649 | FL | MD | Pharmacist |
| PA9104243 | FL | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1195776000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1354752000000",
"number": "1912188657",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 66087",
"city": "ORANGE PARK",
"state": "FL",
"postal_code": "320650019"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "430 COLLEGE DR",
"address_2": "SUITES 100, 102, 104",
"city": "MIDDLEBURG",
"state": "FL",
"postal_code": "320688530",
"telephone_number": "904-730-5774"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VANETTEN-RUNTE",
"first_name": "AUDREY",
"credential": "PHARMD, PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-11-23",
"last_updated": "2012-12-06",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "FL",
"license": "PA9104243",
"primary": false
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "FL",
"license": "PS33649",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Middleburg, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 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.