Provider Demographics
NPI:1811618382
Name:PRIMARY CARE NURSE PRACTITIONERS
Entity type:Organization
Organization Name:PRIMARY CARE NURSE PRACTITIONERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:APRN
Authorized Official - Prefix:MS
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:GAYE
Authorized Official - Last Name:CLEMONS
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:407-579-1450
Mailing Address - Street 1:2208 KENTUCKY DERBY DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32825-8751
Mailing Address - Country:US
Mailing Address - Phone:407-579-1450
Mailing Address - Fax:
Practice Address - Street 1:2208 KENTUCKY DERBY DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32825-8751
Practice Address - Country:US
Practice Address - Phone:407-579-1450
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRIMARY CARE NURSE PRACTITIONERS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-09-05
Last Update Date:2022-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty