Provider Demographics
NPI:1093226623
Name:ADVANCED PRACTICE CLINICAL CONSULTANTS LLC
Entity type:Organization
Organization Name:ADVANCED PRACTICE CLINICAL CONSULTANTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:SCARDINA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:419-270-1038
Mailing Address - Street 1:6239 FALLEN TIMBERS LN
Mailing Address - Street 2:
Mailing Address - City:MAUMEE
Mailing Address - State:OH
Mailing Address - Zip Code:43537-9361
Mailing Address - Country:US
Mailing Address - Phone:419-270-1038
Mailing Address - Fax:
Practice Address - Street 1:6239 FALLEN TIMBERS LN
Practice Address - Street 2:
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537-9361
Practice Address - Country:US
Practice Address - Phone:419-270-1038
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-23
Last Update Date:2018-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty