Provider Demographics
NPI:1467676437
Name:NP EXTENDER SERVICE LLC
Entity type:Organization
Organization Name:NP EXTENDER SERVICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:M
Authorized Official - Middle Name:SANDRA
Authorized Official - Last Name:DAVANZO MBR
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:727-465-8515
Mailing Address - Street 1:200 2ND AVE S
Mailing Address - Street 2:# 340
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-4313
Mailing Address - Country:US
Mailing Address - Phone:727-465-8515
Mailing Address - Fax:727-867-2119
Practice Address - Street 1:200 2ND AVE S
Practice Address - Street 2:# 340
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-4313
Practice Address - Country:US
Practice Address - Phone:727-465-8515
Practice Address - Fax:727-867-2119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1740872363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Multi-Specialty