Look up the most recent NPI and PECOS records

Althea M Buckner

Nurse Practitioner

Physician Assistants & Advanced Practice Nursing Providers

7975 Lake Underhill Rd Ste 220b, Orlando, FL 32822-8202

PECOS Enrollment

Based on the most recent information from CMS, provider Althea M Buckner does not have current enrollment records in PECOS.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Not Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records 3 days ago.

Profile Details

Provider ID
1669792735
Provider Type
Individual
Full Name
Buckner, Althea M
Credential
APRN

Gender
Female
Sole Proprietor
No
Enumeration Date
6/10/2010
Last Updated
4/4/2019

Contact Information

Practice Location

7975 Lake Underhill Rd Ste 220b, Orlando, FL 32822-8202

(407) 303-6772

(407) 303-6775

Mailing Location

501 SE Osceola St, Ste 301, Stuart, FL 34994-2347

(772) 223-5955

(772) 223-5954

Provider Taxonomies

Code	Description	License
Code 363LF0000X Primary	Description Nurse Practitioner Physician Assistants & Advanced Practice Nursing Providers	License ARNP9192140 Florida
Code 363L00000X	Description Nurse Practitioner Physician Assistants & Advanced Practice Nursing Providers	License ARNP 9192140 Florida

Provider Identifiers

ID	Description	Issuer
ID 013940000	Description Medicaid	Issuer Unlisted Florida

Althea M Buckner

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Code

Description

License

Provider Identifiers

ID

Description

Issuer

ID

Description

Issuer

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Nelson Soto, Anthony

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Dieguez, Yuleidi

Tobillo, Emlyn Tanuan