LTSU Healthcare – Primary Care Nurse Practitioner, NPI 1720597693
Primary Care Nurse Practitioner
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for LTSU Healthcare
4301 32ND ST W STE C2
BRADENTON, FL 342052748
Phone: (941) 713-2429
Type: Mailing
2015 SAINT GEORGE DR
BRADENTON, FL 342081539
Phone: (941) 720-6985
Fax: (574) 990-4411
Type: Location
3001 58TH TER E
BRADENTON, FL 342035374
Phone: (941) 720-6985
Type: Mailing
5214 69th St E
Palmetto, FL 342219397
Phone: (941) 720-6985
Type: Location
4301 32nd St W Ste C2
Bradenton, FL 342052748
Phone: (941) 713-2429
Fax: (574) 990-4411
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: 2017-12-19
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Past revalidation due date
Earliest CMS due date was 2023-12-31 (891 days ago).
Enrollment records
1
Earliest due date
2023-12-31
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 |
|---|---|---|---|---|
| O20171219003249 | O | Clinic/Group Practice | FL | 2023-12-31 |
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 34205)
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