Provider Demographics
NPI:1619597382
Name:FAPMC, LLC
Entity Type:Organization
Organization Name:FAPMC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIBBON
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:919-886-9005
Mailing Address - Street 1:2518 SE PINELAND DR
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-8045
Mailing Address - Country:US
Mailing Address - Phone:919-886-9005
Mailing Address - Fax:
Practice Address - Street 1:2518 SE PINELAND DR
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-8045
Practice Address - Country:US
Practice Address - Phone:919-886-9005
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-22
Last Update Date:2020-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty