Unknown Individual – Family Nurse Practitioner, NPI 1033365143

Family Nurse Practitioner

Unknown Individual is a healthcare provider. based in Ormond beach, Florida. specializing in Family Nurse Practitioner. They hold a License No. 3244842 (FL). The NPI Number for Unknown Individual is 1033365143

Main info

Organization

Inactive

24 Years Of Experience

Accepts Medicare Assignment

Name

Unknown Individual

NPI

1033365143

Phone

(386) 682-3564

Address

136 HILLDALE AVE

Deactivation Date

5 February 2026

Doctor Profile

Medical School Name

OTHER

Secondary Phone

3866727113

Graduation Year

2002 (24 years ago)

PAC ID

3678516903

Group Practice PAC ID

3173429180

Professional Enrollment ID

I20050607000851

Data current as of

20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology

Experience14

Completeness75

Years active:0State licenses:1Digital endpointsOther names

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Provider Addresses for Unknown Individual

136, Hilldale Avenue, Ormond Beach, Volusia County, Florida, 32176, United States
ORMOND BEACH, FL 321765724
Phone: (386) 682-3564
Fax: (386) 677-7476
Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 32176)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.

PAC ID: 3173429180View full group profile