Carol L Takis, PA C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA9103292 Issued in FL

Practice address

1135 Lake Ave
Clermont, FL 34711

Phone

(352) 394-4035

Fax

(352) 241-0896

NPI assigned

Nov 8, 2006

Last updated

Apr 22, 2020By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Clermont Medical Center PA

  • Family Medicine Physician
  • Clermont, FL
  • NPI 1861557357
  Medicare reassignment

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

{
    "created_epoch": "1162944000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1587513600000",
    "number": "1922178706",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 121009",
            "city": "CLERMONT",
            "state": "FL",
            "postal_code": "34712",
            "telephone_number": "352-394-4035",
            "fax_number": "352-241-0896"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1135 LAKE AVE",
            "city": "CLERMONT",
            "state": "FL",
            "postal_code": "34711",
            "telephone_number": "352-394-4035",
            "fax_number": "352-241-0896"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAKIS",
        "first_name": "CAROL",
        "middle_name": "L",
        "credential": "PA C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-08",
        "last_updated": "2020-04-22",
        "certification_date": "2020-04-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9103292",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "PA9103292",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jessi Tabarquino, PA-C
• Amel Tabet Aoul, MD
• Andrea Taboada Mendez
• Nicholas James Tabor
• Jennifer Tai, O.D.
• Nishant Tarunkumar Talati, PHARM D
• Howard James Tan
• Andrea Estefania Tapia
• Rami Tarabay, MD
• Shahrzad Tarafdar Haghighat, M.D.

• Physician Assistant in Clermont, FL
• Providers in Clermont, FL by specialty
• Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.