Provider Demographics
NPI:1922661800
Name:DORCUS HEALTHCARE SERVICES LLC
Entity Type:Organization
Organization Name:DORCUS HEALTHCARE SERVICES LLC
Other - Org Name:DORCUS HEALTHCARE SERVICES ,LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:NURSE PRATITIONER
Authorized Official - Prefix:
Authorized Official - First Name:LATOSHA
Authorized Official - Middle Name:D
Authorized Official - Last Name:TRIPLET
Authorized Official - Suffix:
Authorized Official - Credentials:AGNP-C
Authorized Official - Phone:757-842-3824
Mailing Address - Street 1:105 GREYSTONE DR
Mailing Address - Street 2:
Mailing Address - City:GUYTON
Mailing Address - State:GA
Mailing Address - Zip Code:31312-5548
Mailing Address - Country:US
Mailing Address - Phone:757-842-3824
Mailing Address - Fax:
Practice Address - Street 1:105 GREYSTONE DR
Practice Address - Street 2:
Practice Address - City:GUYTON
Practice Address - State:GA
Practice Address - Zip Code:31312-5548
Practice Address - Country:US
Practice Address - Phone:757-842-3824
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-17
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA83-442501OtherINTERNAL REVENUE SERVICES