Provider Demographics
NPI:1679022289
Name:NEWMAN, THEODORE (ARNP)
Entity type:Individual
Prefix:
First Name:THEODORE
Middle Name:
Last Name:NEWMAN
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1224 SLIGH BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-1108
Mailing Address - Country:US
Mailing Address - Phone:321-841-0903
Mailing Address - Fax:321-841-4085
Practice Address - Street 1:1224 SLIGH BLVD STE A
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-1108
Practice Address - Country:US
Practice Address - Phone:321-841-0903
Practice Address - Fax:321-841-4085
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-23
Last Update Date:2025-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9388429363L00000X
FLAPRN9388429363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL018952300Medicaid
FLIS769ZMedicare PIN