Provider Demographics
NPI:1043972102
Name:PREMIER HEALTH PLUS LLC
Entity Type:Organization
Organization Name:PREMIER HEALTH PLUS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:G
Authorized Official - Last Name:HERNANADEZ
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:941-347-8912
Mailing Address - Street 1:3691 TAMIAMI TRL
Mailing Address - Street 2:
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33950-7228
Mailing Address - Country:US
Mailing Address - Phone:941-347-8912
Mailing Address - Fax:
Practice Address - Street 1:3691 TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33950-7228
Practice Address - Country:US
Practice Address - Phone:941-347-8912
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-06
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAPRN9335689OtherLICENSE