Provider Demographics
NPI:1942512694
Name:MOBILE FAMILY HEALTH NURSE PRACTITIONER CARE PLLC
Entity Type:Organization
Organization Name:MOBILE FAMILY HEALTH NURSE PRACTITIONER CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:MS
Authorized Official - First Name:ANN
Authorized Official - Middle Name:M
Authorized Official - Last Name:RHODES
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:845-641-7277
Mailing Address - Street 1:30 STILL HILL RD
Mailing Address - Street 2:
Mailing Address - City:SANDY HOOK
Mailing Address - State:CT
Mailing Address - Zip Code:06482-1313
Mailing Address - Country:US
Mailing Address - Phone:845-641-7277
Mailing Address - Fax:203-304-1048
Practice Address - Street 1:30 STILL HILL RD
Practice Address - Street 2:
Practice Address - City:SANDY HOOK
Practice Address - State:CT
Practice Address - Zip Code:06482-1313
Practice Address - Country:US
Practice Address - Phone:845-641-7277
Practice Address - Fax:203-304-1048
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-10
Last Update Date:2015-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF333112-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03217461Medicaid
NY03217461Medicaid