Provider Demographics
NPI:1972059160
Name:ADVANCED PRACTICE PRIMARY CARE AT HOME
Entity Type:Organization
Organization Name:ADVANCED PRACTICE PRIMARY CARE AT HOME
Other - Org Name:NO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EVANGELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:440-371-1491
Mailing Address - Street 1:5209 SEVEN PINES DR
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44053-3315
Mailing Address - Country:US
Mailing Address - Phone:440-371-1491
Mailing Address - Fax:
Practice Address - Street 1:5209 SEVEN PINES DR
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44053-3315
Practice Address - Country:US
Practice Address - Phone:440-371-1491
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-29
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.15775-NP364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily HealthGroup - Single Specialty