Healthcare Provider Details

I. General information

NPI: 1073839718
Provider Name (Legal Business Name): GERIATRIC SOLUTIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2010
Last Update Date: 12/02/2022
Certification Date: 12/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5804 INDIAN PINES BLVD
FORT PIERCE FL
34951-2302
US

IV. Provider business mailing address

5804 INDIAN PINES BLVD
FORT PIERCE FL
34951-2302
US

V. Phone/Fax

Practice location:
  • Phone: 772-828-3752
  • Fax: 772-302-3518
Mailing address:
  • Phone: 772-828-3752
  • Fax: 772-302-3518

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MRS. MADETRIC NAFAYE WOOD
Title or Position: GERIATRIC NURSE PRACTITIONER
Credential: ARNP, GNP-BC
Phone: 850-322-1895