Provider Demographics
NPI:1558948455
Name:ALL FAMILY WALK-IN CLINIC LLC
Entity Type:Organization
Organization Name:ALL FAMILY WALK-IN CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:352-600-8822
Mailing Address - Street 1:13462 TAFT ST
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34613-6820
Mailing Address - Country:US
Mailing Address - Phone:352-600-8822
Mailing Address - Fax:352-600-8883
Practice Address - Street 1:13462 TAFT STREET
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34613
Practice Address - Country:US
Practice Address - Phone:352-600-8822
Practice Address - Fax:352-600-8883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-26
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty