Healthcare Provider Details

I. General information

NPI: 1811749062
Provider Name (Legal Business Name): PRIMACARE HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2024
Last Update Date: 04/02/2024
Certification Date: 04/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5800 49TH AVE N STE S103
KENNETH CITY FL
33709-3563
US

IV. Provider business mailing address

5800 49TH AVE N STE S103
KENNETH CITY FL
33709-3563
US

V. Phone/Fax

Practice location:
  • Phone: 727-823-4848
  • Fax: 727-823-4880
Mailing address:
  • Phone: 727-823-4848
  • Fax: 727-823-4880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: TRACY HAUGHTON
Title or Position: OFFICE MANAGER
Credential:
Phone: 727-823-4848