Provider Demographics
NPI:1710613096
Name:AMBIANCE PRIMARY CARE
Entity Type:Organization
Organization Name:AMBIANCE PRIMARY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REGINE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOSIE
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:321-482-4933
Mailing Address - Street 1:1026 BEXHILL DR
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-5193
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12006 VEIRS MILL RD
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20906-4513
Practice Address - Country:US
Practice Address - Phone:301-471-8846
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-28
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care