Provider Demographics
NPI:1689191314
Name:PINKARD, PHYLLIS LANETTE (NIC MASTER)
Entity Type:Individual
Prefix:MRS
First Name:PHYLLIS
Middle Name:LANETTE
Last Name:PINKARD
Suffix:
Gender:F
Credentials:NIC MASTER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2840 NW 2ND AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-6692
Mailing Address - Country:US
Mailing Address - Phone:800-233-5976
Mailing Address - Fax:561-347-7928
Practice Address - Street 1:2840 NW 2ND AVE STE 104
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-6692
Practice Address - Country:US
Practice Address - Phone:800-233-5976
Practice Address - Fax:561-347-7928
Is Sole Proprietor?:No
Enumeration Date:2017-08-23
Last Update Date:2017-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLP526672627580171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter