Provider Demographics
NPI:1790453041
Name:COMPASSIONATE CARE PRIMARY SERVICE
Entity Type:Organization
Organization Name:COMPASSIONATE CARE PRIMARY SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIRONADA
Authorized Official - Middle Name:GROSS
Authorized Official - Last Name:STRANGE
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:352-284-4095
Mailing Address - Street 1:18490 NE 76TH LN
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:FL
Mailing Address - Zip Code:32696-3810
Mailing Address - Country:US
Mailing Address - Phone:352-284-4095
Mailing Address - Fax:641-323-5203
Practice Address - Street 1:18490 NE 76TH LN
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:FL
Practice Address - Zip Code:32696-3810
Practice Address - Country:US
Practice Address - Phone:352-284-4095
Practice Address - Fax:641-323-5203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-01
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care