Basic Information
| Provider Information | |||||||||
| NPI: | 1629256359 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JAMES | ||||||||
| FirstName: | MARGARET | ||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6101 LAKE ELLENOR DR | ||||||||
| Address2: | SUITE 105 | ||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328094616 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4073228645 | ||||||||
| FaxNumber: | 4073228725 | ||||||||
| Practice Location | |||||||||
| Address1: | 6101 LAKE ELLENOR DR | ||||||||
| Address2: | SUITE 105 | ||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328094616 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4073228645 | ||||||||
| FaxNumber: | 4073228725 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/05/2008 | ||||||||
| LastUpdateDate: | 03/13/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0200X | ARNP1983452 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 025040601 | 05 | FL | MEDICAID | 01282000 | 01 | FL | AMERIGROUP | OTHER | 279236 | 01 | WELLCARE | OTHER | 591741286 | 01 | FL | TRICARE | OTHER |