Unknown Individual – Nurse Practitioner, NPI 1063400356

Unknown Individual is a healthcare provider. based in Frostproof, Florida. specializing in Nurse Practitioner. They hold a License No. ARNP9178846 (FL). The NPI Number for Unknown Individual is 1063400356

Main info

Organization
Inactive
Name
Unknown Individual
NPI
1063400356
Phone
(863) 635-4891
Address
109 W WALL ST
Deactivation Date
4 March 2022
Data current as of
19 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

  • 109, West Wall Street, Frostproof, Polk County, Florida, 33843, United States

    FROSTPROOF, FL 338432043

    Phone: (863) 635-4891

    Fax: (863) 635-3545

    Type: Location

  • 950 COUNTY ROAD 17A W

    AVON PARK, FL 338252164

    Phone: (863) 452-3000

    Fax: (863) 452-3069

    Type: Mailing

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

CMS reports 1 Open Payments records for all available years, with a total value of $115.

Total Amount is formed as General ($115) + Research ($0) + Ownership ($0) = $115.

Last reported payment date: 2023-05-18 • Largest payer in this snapshot: Incyte Corporation ($115).

Total Amount

$115

General + Research + Ownership

Payments

1

Total payment records

General Amount

$115

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2023-05-18

Latest reported date

Top Companies

Largest payers in this snapshot

CompanyAmount
Incyte Corporation$115
View all Open Payments →|Open Payments Risk Radar →

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 33843)

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Reviews

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Frequently asked questions

What is the 10-digit NPI for Unknown Individual?
Unknown Individual — NPI 1063400356 — is the standard way to identify this listing.
Why might Unknown Individual appear inactive while still practicing?
We display what the registry publishes: Unknown Individual appears inactive there.
What is Unknown Individual's primary classification?
Nurse Practitioner is the headline specialty for Unknown Individual here. Clinical services aligned with this taxonomy classification.
What address line appears for Unknown Individual?
Unknown Individual's geographic hint is Frostproof, Florida in our summary view.
Why does Unknown Individual have multiple addresses?
2 practice locations appear in the available data. Multiple addresses are common for hospital privileges, telehealth, or multi-site groups.

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