Provider Demographics
NPI:1891438321
Name:DR. PALES HEALTHCARE PROVIDER LLC
Entity Type:Organization
Organization Name:DR. PALES HEALTHCARE PROVIDER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:PALES
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:407-683-9205
Mailing Address - Street 1:109 AMBERSWEET WAY # 331
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33897-8418
Mailing Address - Country:US
Mailing Address - Phone:407-683-9205
Mailing Address - Fax:
Practice Address - Street 1:8390 CHAMPIONS GATE BLVD
Practice Address - Street 2:SUITE #108
Practice Address - City:FOUR CORNERS
Practice Address - State:FL
Practice Address - Zip Code:33896
Practice Address - Country:US
Practice Address - Phone:407-683-9205
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-13
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty