Provider Demographics
NPI:1518467935
Name:FAMILY CENTERED PRIMARY CARE LLC
Entity Type:Organization
Organization Name:FAMILY CENTERED PRIMARY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TERI
Authorized Official - Middle Name:L
Authorized Official - Last Name:NIES
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:239-220-8875
Mailing Address - Street 1:4760 TAMIAMI TRL N STE 24
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34103-3065
Mailing Address - Country:US
Mailing Address - Phone:239-220-8875
Mailing Address - Fax:
Practice Address - Street 1:4760 TAMIAMI TRL N STE 24
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34103-3065
Practice Address - Country:US
Practice Address - Phone:239-220-8875
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-13
Last Update Date:2018-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9220215363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty