Provider Demographics
NPI:1003587361
Name:ADVANCED CARE CONSULTANTS, LLC
Entity Type:Organization
Organization Name:ADVANCED CARE CONSULTANTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALTIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:LANDIS
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:954-317-9914
Mailing Address - Street 1:9600 W SAMPLE RD STE 300
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-4035
Mailing Address - Country:US
Mailing Address - Phone:917-375-0524
Mailing Address - Fax:
Practice Address - Street 1:9600 W SAMPLE RD STE 300
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-4035
Practice Address - Country:US
Practice Address - Phone:917-375-0524
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-25
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty