Provider Demographics
NPI:1598366403
Name:PREMIERE SENIOR SERVICES
Entity Type:Organization
Organization Name:PREMIERE SENIOR SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADVANCED PRACTICE REGISTERED NURSE
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:WALTER
Authorized Official - Last Name:LOFTON
Authorized Official - Suffix:III
Authorized Official - Credentials:APRN
Authorized Official - Phone:954-548-1568
Mailing Address - Street 1:13935 S CYPRESS COVE CIR
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33325-6742
Mailing Address - Country:US
Mailing Address - Phone:954-548-1568
Mailing Address - Fax:954-827-7945
Practice Address - Street 1:13935 S CYPRESS COVE CIR
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33325-6742
Practice Address - Country:US
Practice Address - Phone:954-548-1568
Practice Address - Fax:954-827-7945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-06
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty