Provider Demographics
NPI:1689411126
Name:PADMAKARAN, AMBIKA
Entity type:Individual
Prefix:
First Name:AMBIKA
Middle Name:
Last Name:PADMAKARAN
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 1:3644 VEGA CREEK DR
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34772-8384
Mailing Address - Country:US
Mailing Address - Phone:813-770-9856
Mailing Address - Fax:
Practice Address - Street 1:3644 VEGA CREEK DR
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34772-8384
Practice Address - Country:US
Practice Address - Phone:813-770-9856
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-11
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11033561363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily