Provider Demographics
NPI:1972249530
Name:PRIMARY CARE OF ORANGE CITY LLC
Entity Type:Organization
Organization Name:PRIMARY CARE OF ORANGE CITY LLC
Other - Org Name:HOME WOUND CARE FLORIDA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:CROKER
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:386-473-3553
Mailing Address - Street 1:341 W MINNESOTA AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32763-2205
Mailing Address - Country:US
Mailing Address - Phone:386-316-5439
Mailing Address - Fax:
Practice Address - Street 1:135 E MINNESOTA AVE
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-2312
Practice Address - Country:US
Practice Address - Phone:386-316-5439
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRIMARY CARE OF ORANGE CITY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-05-06
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty