Provider Demographics
NPI:1710577184
Name:JUANITAC PERKINS FNP-BC HEALTHCARE, P.A
Entity Type:Organization
Organization Name:JUANITAC PERKINS FNP-BC HEALTHCARE, P.A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUANITA
Authorized Official - Middle Name:CONSUELA
Authorized Official - Last Name:PERKINS
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:919-943-9515
Mailing Address - Street 1:1707 AUTUMN RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27712-4601
Mailing Address - Country:US
Mailing Address - Phone:919-943-9515
Mailing Address - Fax:
Practice Address - Street 1:3209 GUESS RD STE 108
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-2692
Practice Address - Country:US
Practice Address - Phone:919-943-9515
Practice Address - Fax:866-788-7843
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-20
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1225163744OtherNPI