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NPI Code Detail

MEDICARE: CHAMPIONS FOR HEALING LLC

MEDICARE: CHAMPIONS FOR HEALING 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
1363LP2300XPrimary Care Nurse Practitioner

General Provider Information

NPI Number : 1720586860
Entity Type Code : Organization
Provider Name (Legal Business Name) : CHAMPIONS FOR HEALING LLC
Provider Business Mailing Address
First Line : 2054 VISTA PKWY STE 400
Second Line :
City : WEST PALM BEACH
State : FL
Zip : 33411-6742
Country : US
Telephone Number : 305-905-9757
Fax Number :
Provider Business Practice Location Address
First Line : 2054 VISTA PKWY STE 400
Second Line :
City : WEST PALM BEACH
State : FL
Zip : 33411-6742
Country : US
Telephone Number : 305-905-9757
Fax Number :
Authorized Official
Title or Position : ARNP
Name : MRS. JINGA OGLESBY-BRIHM
Credential : ARNP
Telephone Number : 305-905-9757
Provider Enumeration Date : 01/23/2018
Last Update Date : 08/12/2019

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Directions to “CHAMPIONS FOR HEALING LLC ” Practice Location

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