Healthcare Provider Details

I. General information

NPI: 1669443156
Provider Name (Legal Business Name): CMS FT. PIERCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 S 23RD ST
FORT PIERCE FL
34950-4804
US

IV. Provider business mailing address

1701 S 23RD ST
FORT PIERCE FL
34950-4804
US

V. Phone/Fax

Practice location:
  • Phone: 772-467-6000
  • Fax: 772-467-6092
Mailing address:
  • Phone: 772-467-6000
  • Fax: 772-467-6092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License NumberN/A GOVERNMENT AGENC
License Number StateFL

VIII. Authorized Official

Name: MS. SHARON A. ARMSTRONG
Title or Position: PROGRAM MANAGER
Credential:
Phone: 772-467-6008