MAGNOLIA ADULT (NPI# 1033477567) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1033477567 |
| Entity Type | Organization |
| Organization Name | MAGNOLIA ADULT |
| Practice Address |
1140 Sw Bascom Norris Dr Ste 105 Lake City FL 32025-1329 |
| Practice Telephone | 3867553300 |
| Practice Fax Number | 3867558595 |
| Mailing Telephone | 3867553300 |
| Mailing Fax Number | 3867558595 |
| Enumeration Date | 2012-05-03 |
| Last Update Date | 2012-05-03 |
| Authorized Official Name | IRA D LEE (PRESIDENT) |
| Authorized Official Telephone | 3867553300 |
| Authorized Official Credential | ARNP-C |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LA2200X |
Nurse Practitioner Specialization: Adult Health |
ARNP3091702 | FL | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | 305351200 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841611407 | Magnolia Adult | Nurse Practitioner | 1211 Sw Bascom Norris Dr Ste 201, Lake City, FL 32025-4916 | 2013-12-30 |
| Street Address |
1140 SW BASCOM NORRIS DR STE 105 |
| City | LAKE CITY |
| State | FL |
| Zip Code | 32025-1329 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801438353 | Jennifer Bennett | Pharmacist | 347 Sw Main Blvd Suite 102, Lake City, FL 32025 | 2019-10-16 |
| 1700352838 | Robert J Sansouci IIi IIi | Physical Therapy Assistant | 560 Sw Mcfarlane Ave, Lake City, Fl, 32025, Lake City, FL 32025 | 2018-10-16 |
| 1316442783 | Emily Bailey | Developmental Therapist | 2126 Sw Sisters Welcome Rd, Lake City, FL 32025 | 2018-03-28 |
| 1811446370 | Michelle Hart | Behavioral Analyst | 260 S. Marion Avenue, Bldg. A, Suite 135, Lake City, FL 32025 | 2016-09-26 |
| 1922467646 | Irene Aponte Moreno | Nurse Practitioner | 440 Sw Perimeter Glen, Lake City, FL 32025 | 2016-02-23 |
| 1093186777 | Decarlos Scippio | Counselor | 619 Sw Baya Drive Suite 102, Lake City, FL 32025 | 2015-10-07 |
| 1497132476 | Jamecia Legree | Registered Nurse | 800 Sw Symphony Loop, Bldg 15 Apt 204, Lake City, FL 32025 | 2015-04-29 |
| 1306249149 | Mercy Home Assisted Living Facility LLC | Assisted Living Facility | 184 S.e. Beech Street, Lake City, FL 32025 | 2014-10-08 |
| 1598174344 | Karen Mcdonald | Developmental Therapist | 4523 Se County Road 252, Lake City, FL 32025 | 2014-08-06 |
| 1275944126 | Mohammad Ali Faisal Mdpa | Specialist | 1283 Sw State Rd 47, Ste 104, Lake City, FL 32025 | 2014-05-14 |
| Find all providers in zip 32025 | ||||
| Taxonomy Code | 363LA2200X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Adult Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841760816 | Timothy Paul Cassidy Jr. | Nurse Practitioner | 289 Sw Stonegate Ter Ste 103, Lake City, FL 32024-3457 | 2018-12-03 |
| 1841611407 | Magnolia Adult | Nurse Practitioner | 1211 Sw Bascom Norris Dr Ste 201, Lake City, FL 32025-4916 | 2013-12-30 |
| 1619293867 | Jennifer Goolsby Watson | Nurse Practitioner | 2970 W Us Highway 90, Suite 120, Lake City, FL 32055-4700 | 2010-04-13 |
| 1831266394 | Elizabeth Teuscher Beardsley | Nurse Practitioner | 204 Nw Emporia Gln, Lake City, FL 32055-8516 | 2006-11-29 |
| 1861018988 | Tymber Tatum Terrell | Nurse Practitioner | 410 Sw Silver Palm Dr, Lake City, FL 32024-6757 | 2020-06-24 |
| 1942706452 | Ariel Parnell | Nurse Practitioner | 4367 Nw American Ln, Lake City, FL 32055-4828 | 2018-04-03 |
| 1821538315 | Stephanie Sapp | Nurse Practitioner | 1531 Sw Commercial Gln, Lake City, FL 32025-0454 | 2017-03-02 |
| 1023550696 | Antranika D. Ross | Nurse Practitioner | 2055 Rex Rd, Lake City, GA 30260-3944 | 2016-11-13 |
| 1164769675 | Florida Dermcare, Inc. | Nurse Practitioner | 204 Nw Emporia Gln, Lake City, FL 32055-8516 | 2013-01-04 |
| 1306097076 | Tonna Jeanette Sotolongo | Nurse Practitioner | 619 S Marion Ave, Lake City, FL 32025-5808 | 2008-09-30 |
| Find all providers in LAKE CITY | ||||
Please comment or provide details below to improve the information on MAGNOLIA ADULT.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.