Healthcare Provider Details

I. General information

NPI: 1063439750
Provider Name (Legal Business Name): PK HEALTH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 02/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4113 LITTLE RD UNIT 103
NEW PORT RICHEY FL
34655-1716
US

IV. Provider business mailing address

4113 LITTLE RD UNIT 103
NEW PORT RICHEY FL
34655-1716
US

V. Phone/Fax

Practice location:
  • Phone: 727-376-2880
  • Fax: 727-816-9745
Mailing address:
  • Phone: 727-376-2880
  • Fax: 727-816-9745

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW4995
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberARNP1163702
License Number StateFL

VIII. Authorized Official

Name: MS. DEBORAH LEE PIERCE
Title or Position: MANAGING MEMBER
Credential:
Phone: 727-376-2880