ULTRA HEALTH PROVIDERS OF FLORIDA – Nurse Practitioner, NPI 1528549490
Nurse Practitioner
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for ULTRA HEALTH PROVIDERS OF FLORIDA
2202 W Oak Ave
Plant City, FL 335637222
Phone: (386) 562-4899
Type: Location
10300 4th St N
Saint Petersburg, FL 337163810
Phone: (386) 562-4899
Type: Location
227 SW 62nd Blvd
Gainesville, FL 326072084
Phone: (731) 394-1145
Type: Location
36, Pemberton Cv, Jackson, Madison County, Tennessee, 38305, United States
JACKSON, TN 383055514
Phone: (731) 234-8120
Type: Mailing
105, Asterbrooke Drive, DeLand, Volusia County, Florida, 32724, United States
DELAND, FL 32724
Phone: (731) 234-8120
Type: Location
PO BOX 269092
DEPT 1103
OKLAHOMA CITY, OK 731269092
Phone: (731) 394-1145
Type: Mailing
701 N WILDER RD
PLANT CITY, FL 335667547
Phone: (386) 562-4899
Type: Location
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.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2019-02-19
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Past revalidation due date
Earliest CMS due date was 2024-10-31 (585 days ago).
Enrollment records
1
Earliest due date
2024-10-31
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| O20190219000020 | O | Clinic/Group Practice | FL | 2024-10-31 |
What to do next
- Verify current status on the CMS Revalidation Lookup Tool immediately.
- Complete revalidation in PECOS or contact your Medicare Administrative Contractor (MAC).
- Overdue revalidation can lead to deactivation of Medicare billing privileges.
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 33563)
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