MEDICARE: PREMIER MEDICAL HOUSECALLS 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	363L00000X	Nurse Practitioner	RN9345557	FL

General Provider Information

NPI Number	:	1891206041
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREMIER MEDICAL HOUSECALLS LLC

Provider Business Mailing Address
First Line	:	1825 NW CORPORATE BLVD STE 110
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33431-8554
Country	:	US
Telephone Number	:	772-361-3854
Fax Number	:

Provider Business Practice Location Address
First Line	:	1825 NW CORPORATE BLVD STE 110
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33431-8554
Country	:	US
Telephone Number	:	772-361-3854
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	REBECCA JACQUES
Credential	:	RN
Telephone Number	:	772-361-3854

Provider Enumeration Date	:	10/16/2017
Last Update Date	:	04/10/2018

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