Provider Demographics
NPI:1336901024
Name:THE DOCTOR NURSE FOR HEALTHY AGING LLC
Entity Type:Organization
Organization Name:THE DOCTOR NURSE FOR HEALTHY AGING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRIMARY CARE PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALICE
Authorized Official - Middle Name:W
Authorized Official - Last Name:BRUMLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:561-462-0622
Mailing Address - Street 1:21575 KAPOK CIR
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-3718
Mailing Address - Country:US
Mailing Address - Phone:561-462-0622
Mailing Address - Fax:561-287-8092
Practice Address - Street 1:777 GLADES RD BLDG AZ-79
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-6496
Practice Address - Country:US
Practice Address - Phone:561-297-0502
Practice Address - Fax:561-297-0505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-29
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Multi-Specialty