North Lake Primary Care, P.a.

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

363L00000X Issued in FL

Legal business name

NORTH LAKE PRIMARY CARE, P.A.

Practice address

8022 Saint James Way
Mount Dora, FL 32757-9134

Phone

(352) 516-8931

NPI assigned

Dec 3, 2014

Organization subpart

No

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

Authorized official

Name

Mr. Jeremy E. Creech, ARNP

Title

Proprietor

Phone

(352) 516-8931

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1417564800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1417564800000",
    "number": "1962809145",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8022 SAINT JAMES WAY",
            "city": "MOUNT DORA",
            "state": "FL",
            "postal_code": "327579134",
            "telephone_number": "352-516-8931"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8022 SAINT JAMES WAY",
            "city": "MOUNT DORA",
            "state": "FL",
            "postal_code": "327579134",
            "telephone_number": "352-516-8931"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH LAKE PRIMARY CARE, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-12-03",
        "last_updated": "2014-12-03",
        "status": "A",
        "authorized_official_last_name": "CREECH",
        "authorized_official_first_name": "JEREMY",
        "authorized_official_middle_name": "E.",
        "authorized_official_title_or_position": "PROPRIETOR",
        "authorized_official_telephone_number": "352-516-8931",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "ARNP"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "363L00000X",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "009259700",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Family Nurse Practitioner in Mount Dora, FL
• Providers in Mount Dora, FL by specialty
• Family Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.