Provider Demographics
NPI:1003426305
Name:PRN NP MEDICAL SERVICES LLC
Entity type:Organization
Organization Name:PRN NP MEDICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEAD NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:VANQUIECE
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:850-737-9214
Mailing Address - Street 1:2942 N 24TH ST STE 114
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-7849
Mailing Address - Country:US
Mailing Address - Phone:623-526-5835
Mailing Address - Fax:
Practice Address - Street 1:2942 N 24TH ST STE 114
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-7849
Practice Address - Country:US
Practice Address - Phone:623-526-5835
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-03
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center