Provider Demographics
NPI:1457974602
Name:ADVANCED PRACTITIONER SERVICES
Entity type:Organization
Organization Name:ADVANCED PRACTITIONER SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:MR
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:
Authorized Official - Last Name:KHARONOV
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:732-599-0690
Mailing Address - Street 1:109 AMBERSWEET WAY STE 642
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33897-8418
Mailing Address - Country:US
Mailing Address - Phone:732-599-0690
Mailing Address - Fax:
Practice Address - Street 1:450 ROUTE 50
Practice Address - Street 2:UNIT 4
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711
Practice Address - Country:US
Practice Address - Phone:732-599-0690
Practice Address - Fax:845-327-1074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-22
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty