Provider Demographics
NPI:1558035352
Name:PRIMARY AND TRANSITIONAL CARE SERVICE
Entity Type:Organization
Organization Name:PRIMARY AND TRANSITIONAL CARE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:APRN
Authorized Official - Prefix:
Authorized Official - First Name:KENOL
Authorized Official - Middle Name:
Authorized Official - Last Name:CICERON
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:561-537-9028
Mailing Address - Street 1:1501 11TH ST
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-3038
Mailing Address - Country:US
Mailing Address - Phone:561-537-9028
Mailing Address - Fax:
Practice Address - Street 1:1501 11TH ST
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-3038
Practice Address - Country:US
Practice Address - Phone:561-537-9028
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-04
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty