Provider Demographics
NPI:1720613862
Name:PRIMECARE VENICE LLC
Entity Type:Organization
Organization Name:PRIMECARE VENICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:APRN
Authorized Official - Prefix:
Authorized Official - First Name:KATIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:SPADA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-676-3440
Mailing Address - Street 1:11802 TEMPEST HARBOR LOOP
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34292-3821
Mailing Address - Country:US
Mailing Address - Phone:401-480-0839
Mailing Address - Fax:
Practice Address - Street 1:1531 TAMIAMI TRL S STE 703
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-5569
Practice Address - Country:US
Practice Address - Phone:941-676-3440
Practice Address - Fax:941-303-5552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-09
Last Update Date:2020-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty