Provider Demographics
NPI:1760004774
Name:ADVANCED HEALTHCARE SPECIALIST
Entity Type:Organization
Organization Name:ADVANCED HEALTHCARE SPECIALIST
Other - Org Name:ADVANCED HEALTHCARE SPECIALIST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:FOLES
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:228-596-5749
Mailing Address - Street 1:1120 BROAD AVE
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39501-2414
Mailing Address - Country:US
Mailing Address - Phone:228-596-5749
Mailing Address - Fax:
Practice Address - Street 1:1120 BROAD AVE
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39501-2414
Practice Address - Country:US
Practice Address - Phone:228-596-5749
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-13
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty