Provider Demographics
NPI:1659981777
Name:HER TIME HEALTHCARE LLC
Entity Type:Organization
Organization Name:HER TIME HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ETHERIDGE-BAGLEY
Authorized Official - Suffix:
Authorized Official - Credentials:CNM
Authorized Official - Phone:561-248-0828
Mailing Address - Street 1:12291 76TH RD N
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33412-2277
Mailing Address - Country:US
Mailing Address - Phone:561-248-0828
Mailing Address - Fax:
Practice Address - Street 1:3400 BURNS RD STE 200
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-4347
Practice Address - Country:US
Practice Address - Phone:561-425-9096
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-04
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Single Specialty