Provider Demographics
NPI:1922753508
Name:PRIMARY ONE HEALTHCARE PLLC
Entity Type:Organization
Organization Name:PRIMARY ONE HEALTHCARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VICKY
Authorized Official - Middle Name:
Authorized Official - Last Name:PAUL
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:561-332-4545
Mailing Address - Street 1:433 PLAZA REAL STE 275
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33432-3999
Mailing Address - Country:US
Mailing Address - Phone:561-332-4545
Mailing Address - Fax:888-726-9869
Practice Address - Street 1:433 PLAZA REAL STE 275
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33432-3999
Practice Address - Country:US
Practice Address - Phone:561-332-4545
Practice Address - Fax:888-726-9869
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-13
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty