Provider Demographics
NPI:1811202054
Name:PRECISION PULMONARY NP, INC.
Entity Type:Organization
Organization Name:PRECISION PULMONARY NP, INC.
Other - Org Name:PRECISION PULMONARY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MR
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:M
Authorized Official - Last Name:WOMACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-216-6568
Mailing Address - Street 1:PO BOX 16267
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33766-6267
Mailing Address - Country:US
Mailing Address - Phone:727-216-6568
Mailing Address - Fax:727-494-1468
Practice Address - Street 1:2194 MAIN ST STE O
Practice Address - Street 2:
Practice Address - City:DUNEDIN
Practice Address - State:FL
Practice Address - Zip Code:34698-5697
Practice Address - Country:US
Practice Address - Phone:727-216-6568
Practice Address - Fax:727-494-1468
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-12
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC8066363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty