Provider Demographics
NPI:1942989314
Name:PREFERRED DIRECT FAMILY CARE
Entity Type:Organization
Organization Name:PREFERRED DIRECT FAMILY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SALINA
Authorized Official - Middle Name:
Authorized Official - Last Name:WOMACK
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:352-677-2025
Mailing Address - Street 1:417 N MARKET ST
Mailing Address - Street 2:
Mailing Address - City:BUSHNELL
Mailing Address - State:FL
Mailing Address - Zip Code:33513-5514
Mailing Address - Country:US
Mailing Address - Phone:352-677-2025
Mailing Address - Fax:352-604-0013
Practice Address - Street 1:417 N MARKET ST
Practice Address - Street 2:
Practice Address - City:BUSHNELL
Practice Address - State:FL
Practice Address - Zip Code:33513-5514
Practice Address - Country:US
Practice Address - Phone:352-677-2025
Practice Address - Fax:352-604-0013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-13
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty