Provider Demographics
NPI:1033971064
Name:B-LEEVE PRIMARY CARE, INC
Entity Type:Organization
Organization Name:B-LEEVE PRIMARY CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:QUAWENDELLA
Authorized Official - Middle Name:BAEJUHNE
Authorized Official - Last Name:SKINNER
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:904-239-1343
Mailing Address - Street 1:9570 REGENCY SQUARE BLVD STE 403
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32225-9103
Mailing Address - Country:US
Mailing Address - Phone:904-474-9766
Mailing Address - Fax:
Practice Address - Street 1:9570 REGENCY SQUARE BLVD STE 403
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32225-9103
Practice Address - Country:US
Practice Address - Phone:904-474-9766
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-25
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty