Provider Demographics
NPI:1811749062
Name:PRIMACARE HEALTH, LLC
Entity type:Organization
Organization Name:PRIMACARE HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:HAUGHTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-823-4848
Mailing Address - Street 1:5800 49TH AVE N STE S103
Mailing Address - Street 2:
Mailing Address - City:KENNETH CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33709-3563
Mailing Address - Country:US
Mailing Address - Phone:727-823-4848
Mailing Address - Fax:727-823-4880
Practice Address - Street 1:5800 49TH AVE N STE S103
Practice Address - Street 2:
Practice Address - City:KENNETH CITY
Practice Address - State:FL
Practice Address - Zip Code:33709-3563
Practice Address - Country:US
Practice Address - Phone:727-823-4848
Practice Address - Fax:727-823-4880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-02
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1528064797OtherNPI