Provider Demographics
NPI:1043957350
Name:AGAPE MOBILE MEDICINE
Entity Type:Organization
Organization Name:AGAPE MOBILE MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:APRN
Authorized Official - Prefix:MRS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:LURIE
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:877-724-2736
Mailing Address - Street 1:2050 OLEANDER BLVD APT 1-203
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34950-5315
Mailing Address - Country:US
Mailing Address - Phone:877-724-2736
Mailing Address - Fax:
Practice Address - Street 1:2050 OLEANDER BLVD APT 1-203
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950-5315
Practice Address - Country:US
Practice Address - Phone:772-834-1024
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-18
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Multi-Specialty
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty