Provider Demographics
NPI:1154145480
Name:EHEALTH PROVISIONS
Entity type:Organization
Organization Name:EHEALTH PROVISIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NP
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:LILLY
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:941-404-5453
Mailing Address - Street 1:1435 S OSPREY AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239
Mailing Address - Country:US
Mailing Address - Phone:941-404-5453
Mailing Address - Fax:
Practice Address - Street 1:1435 S OSPREY AVE STE 200
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-2905
Practice Address - Country:US
Practice Address - Phone:941-404-5453
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-13
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty