MEDICARE: VENRA PRIMARY CARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	ME44269	FL

General Provider Information

NPI Number	:	1255475919
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VENRA PRIMARY CARE LLC

Provider Business Mailing Address
First Line	:	1157 S STATE ROAD 7
Second Line	:
City	:	WELLINGTON
State	:	FL
Zip	:	33414-6101
Country	:	US
Telephone Number	:	561-795-3330
Fax Number	:	561-795-1030

Provider Business Practice Location Address
First Line	:	10131 W FOREST HILL BLVD
Second Line	:	SUITE 140
City	:	WELLINGTON
State	:	FL
Zip	:	33414-6156
Country	:	US
Telephone Number	:	561-793-7300
Fax Number	:	561-793-8868

Authorized Official
Title or Position	:	OWNER
Name	:	DR. KRISHNA TRIPURANENI
Credential	:	M.D.
Telephone Number	:	561-795-3330

Provider Enumeration Date	:	02/16/2007
Last Update Date	:	08/22/2020

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Directions to “VENRA PRIMARY CARE LLC ” Practice Location

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