Provider Demographics
NPI:1336835404
Name:FULL CIRCLE CARE PLLC
Entity Type:Organization
Organization Name:FULL CIRCLE CARE PLLC
Other - Org Name:FULL CIRCLE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:STORY-SALACUP
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:702-513-5533
Mailing Address - Street 1:2110 E FLAMINGO RD STE 105
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-5191
Mailing Address - Country:US
Mailing Address - Phone:702-695-2084
Mailing Address - Fax:
Practice Address - Street 1:2110 E FLAMINGO RD STE 105
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-5191
Practice Address - Country:US
Practice Address - Phone:702-695-2084
Practice Address - Fax:702-537-0981
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-12
Last Update Date:2024-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty