Provider Demographics
NPI:1750776811
Name:DACRIS HEALTH PRACTITIONERS, INC
Entity type:Organization
Organization Name:DACRIS HEALTH PRACTITIONERS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LUDIVINA
Authorized Official - Middle Name:
Authorized Official - Last Name:VIGIL
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:786-312-0407
Mailing Address - Street 1:4880 NW 108TH PL
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33178-4335
Mailing Address - Country:US
Mailing Address - Phone:786-312-0407
Mailing Address - Fax:
Practice Address - Street 1:4880 NW 108TH PL
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33178-4335
Practice Address - Country:US
Practice Address - Phone:786-312-0407
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-05
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9229298363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty