Provider Demographics
NPI:1851924476
Name:EXPRESS CARE WALK IN CLINIC LLC
Entity Type:Organization
Organization Name:EXPRESS CARE WALK IN CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OF ENTITY
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:POWELL-GILLIS
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, APRN, FNP-BC
Authorized Official - Phone:954-366-5182
Mailing Address - Street 1:1490 N STATE ROAD 7 STE B
Mailing Address - Street 2:
Mailing Address - City:MARGATE
Mailing Address - State:FL
Mailing Address - Zip Code:33063-2858
Mailing Address - Country:US
Mailing Address - Phone:954-366-5182
Mailing Address - Fax:
Practice Address - Street 1:1490 N STATE ROAD 7 STE B
Practice Address - Street 2:
Practice Address - City:MARGATE
Practice Address - State:FL
Practice Address - Zip Code:33063-2858
Practice Address - Country:US
Practice Address - Phone:954-366-5182
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-21
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care