Healthcare Provider Details

I. General information

NPI: 1710344858
Provider Name (Legal Business Name): CONNECT CARE CLINIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2016
Last Update Date: 01/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

264 SW 1ST CT
DEERFIELD BEACH FL
33441-3304
US

IV. Provider business mailing address

264 SW 1ST CT
DEERFIELD BEACH FL
33441-3304
US

V. Phone/Fax

Practice location:
  • Phone: 954-825-5090
  • Fax:
Mailing address:
  • Phone: 954-825-5090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MS. LASHAWN MCCRAY
Title or Position: PRESIDENT
Credential: ARNP
Phone: 954-825-5090