Provider Demographics
NPI:1184314254
Name:INFINITI HEALTHCARE LLC
Entity type:Organization
Organization Name:INFINITI HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MIRANDA
Authorized Official - Middle Name:ALLYCE
Authorized Official - Last Name:HAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:859-397-8199
Mailing Address - Street 1:1018 E NEW CIRCLE RD STE 205
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40505-4138
Mailing Address - Country:US
Mailing Address - Phone:859-303-5918
Mailing Address - Fax:
Practice Address - Street 1:1018 E NEW CIRCLE RD STE 205
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40505-4138
Practice Address - Country:US
Practice Address - Phone:859-303-5918
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-11
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty