Provider Demographics
NPI:1144822701
Name:TALATI, RUNALI
Entity type:Individual
Prefix:
First Name:RUNALI
Middle Name:
Last Name:TALATI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39913 SUN GLO CT
Mailing Address - Street 2:
Mailing Address - City:LADY LAKE
Mailing Address - State:FL
Mailing Address - Zip Code:32159-3539
Mailing Address - Country:US
Mailing Address - Phone:516-503-6048
Mailing Address - Fax:
Practice Address - Street 1:39913 SUN GLO CT
Practice Address - Street 2:
Practice Address - City:LADY LAKE
Practice Address - State:FL
Practice Address - Zip Code:32159-3539
Practice Address - Country:US
Practice Address - Phone:516-503-6048
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-09
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11009939363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care