Provider Demographics
NPI:1972191922
Name:INNOVATIVE PRIMARY CARE FAMILY PRACTICE, LLC
Entity Type:Organization
Organization Name:INNOVATIVE PRIMARY CARE FAMILY PRACTICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:TAPPER
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:786-423-8500
Mailing Address - Street 1:6950 SW 26TH ST
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33023-3743
Mailing Address - Country:US
Mailing Address - Phone:786-540-0611
Mailing Address - Fax:786-814-1224
Practice Address - Street 1:1400 NE MIAMI GARDENS DR STE 104
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33179-4843
Practice Address - Country:US
Practice Address - Phone:786-540-0611
Practice Address - Fax:786-814-1224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-05
Last Update Date:2021-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty