Provider Demographics
NPI:1811580996
Name:PORTIA F BOATWRIGHT INC
Entity type:Organization
Organization Name:PORTIA F BOATWRIGHT INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:PORTIA
Authorized Official - Middle Name:FIERRA
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:561-633-0104
Mailing Address - Street 1:2225 SW NEWPORT ISLES BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-4575
Mailing Address - Country:US
Mailing Address - Phone:561-633-0104
Mailing Address - Fax:888-411-5724
Practice Address - Street 1:2225 SW NEWPORT ISLES BLVD
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34953-4575
Practice Address - Country:US
Practice Address - Phone:561-633-0104
Practice Address - Fax:888-411-5724
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-18
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty