Healthcare Provider Details

I. General information

NPI: 1568723898
Provider Name (Legal Business Name): AVENIR VENTURES, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2012
Last Update Date: 03/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

236 W GARDEN ST SUITE 4
PENSACOLA FL
32502-5755
US

IV. Provider business mailing address

5959 S SHERWOOD FOREST BLVD
BATON ROUGE LA
70816-6038
US

V. Phone/Fax

Practice location:
  • Phone: 850-469-0020
  • Fax: 850-469-0097
Mailing address:
  • Phone: 225-292-2031
  • Fax: 225-295-9678

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberHCC9472
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberHCC9472
License Number StateFL

VIII. Authorized Official

Name: RONALD LABORDE
Title or Position: PRESIDENT
Credential:
Phone: 225-292-2031