Healthcare Provider Details

I. General information

NPI: 1700831161
Provider Name (Legal Business Name): PREMIER CARE PROFESSIONALS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 05/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4725 US HIGHWAY 98 S SUITE 102
LAKELAND FL
33812-4334
US

IV. Provider business mailing address

111 WEBB DR
DAVENPORT FL
33837-3962
US

V. Phone/Fax

Practice location:
  • Phone: 863-646-9191
  • Fax: 863-646-5252
Mailing address:
  • Phone: 863-588-1424
  • Fax: 863-646-5252

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberME0072440
License Number StateFL

VIII. Authorized Official

Name: MR. JEFF SETTEMBRINO
Title or Position: CHAIRMAN
Credential:
Phone: 863-646-9191