Provider Demographics
NPI:1972536530
Name:KUPERBERG, KAREN G (ARNP)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:G
Last Name:KUPERBERG
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 W NORTH BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-5063
Mailing Address - Country:US
Mailing Address - Phone:352-728-3000
Mailing Address - Fax:352-787-1165
Practice Address - Street 1:600 W NORTH BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-5063
Practice Address - Country:US
Practice Address - Phone:352-728-3000
Practice Address - Fax:352-787-1165
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9178626363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00352228OtherMEDICARE RR
FLY058KZMedicare ID - Type Unspecified
FLQ68931Medicare UPIN