Provider Demographics
NPI:1235801366
Name:ADVANCE FAMILY CLINIC LLC
Entity Type:Organization
Organization Name:ADVANCE FAMILY CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FNP
Authorized Official - Prefix:
Authorized Official - First Name:EZINNE
Authorized Official - Middle Name:BLESSING
Authorized Official - Last Name:CHUKWUOCHA
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE PRACTITIONER
Authorized Official - Phone:832-616-6718
Mailing Address - Street 1:5015 LARK CREEK CT
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-3866
Mailing Address - Country:US
Mailing Address - Phone:832-616-6718
Mailing Address - Fax:
Practice Address - Street 1:5015 LARK CREEK CT
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-3866
Practice Address - Country:US
Practice Address - Phone:832-616-6718
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-28
Last Update Date:2021-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care