Provider Demographics
NPI:1669925590
Name:PRACTITIONERS HEALTHCARE NETWORK
Entity type:Organization
Organization Name:PRACTITIONERS HEALTHCARE NETWORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHN
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:954-668-0287
Mailing Address - Street 1:4788 W COMMERCIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33319-2878
Mailing Address - Country:US
Mailing Address - Phone:954-668-0287
Mailing Address - Fax:954-640-1455
Practice Address - Street 1:9540 HUDSON ST
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33025-4208
Practice Address - Country:US
Practice Address - Phone:954-668-0287
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-27
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3112112261Q00000X, 313M00000X, 251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility