Unknown Individual – Nurse Practitioner, NPI 1962772269
Nurse Practitioner
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for Unknown Individual
12902 MAGNOLIA DRIVE
TAMPA, FL 336129416
Phone: (888) 663-3488
Type: Mailing
121 WHITEHALL DR
ST AUGUSTINE, FL 320865266
Phone: (907) 825-4500
Fax: (904) 825-3672
Type: Location
15211 Cortez Blvd
Brooksville, FL 346136072
Phone: (352) 345-4565
Fax: (352) 596-6051
Type: Location
7015 A C SKINNER PKWY STE 1
JACKSONVILLE, FL 322566932
Phone: (904) 363-2113
Fax: (904) 363-2606
Type: Mailing
14690 SPRING HILL DR STE 305
SPRING HILL, FL 346098102
Phone: (352) 277-5305
Fax: (352) 616-0926
Type: Mailing
15211 CORTEZ BLVD
BROOKSVILLE, FL 346136072
Phone: (352) 345-4565
Fax: (352) 596-6051
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 11 Open Payments records for all available years, with a total value of $193.
Total Amount is formed as General ($193) + Research ($0) + Ownership ($0) = $193.
Last reported payment date: 2023-06-07 • Largest payer in this snapshot: Novartis Pharmaceuticals Corporation ($73).
Total Amount
$193
General + Research + Ownership
Payments
11
Total payment records
General Amount
$193
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2023-06-07
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Novartis Pharmaceuticals Corporation | $73 |
| Janssen Biotech, Inc. | $57 |
| Eisai Inc. | $37 |
| Sumitomo Pharma America, Inc. | $13 |
| PFIZER INC. | $13 |
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: 2013-11-04
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
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 |
|---|---|---|---|---|
| I20131104001677 | I | Nurse Practitioner | FL | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
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 33612)
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