Provider Demographics
NPI:1184218471
Name:GREENE PRESERVE INVESTMENT LLC
Entity Type:Organization
Organization Name:GREENE PRESERVE INVESTMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:
Authorized Official - Last Name:BUCHANAN
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:954-249-7230
Mailing Address - Street 1:3690 SWEET BUTTERCUP DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32822-2957
Mailing Address - Country:US
Mailing Address - Phone:954-249-7230
Mailing Address - Fax:
Practice Address - Street 1:3690 SWEET BUTTERCUP DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822-2957
Practice Address - Country:US
Practice Address - Phone:954-249-7230
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-26
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty