Healthcare Provider Details

I. General information

NPI: 1518177930
Provider Name (Legal Business Name): PRIMACARE HEALTH CENTERS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 02/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3236 DR MARTIN LUTHER KING JR ST N
ST PETERSBURG FL
33704-1202
US

IV. Provider business mailing address

3236 DR MARTIN LUTHER KING JR ST N
ST PETERSBURG FL
33704-1202
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 Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JOHN WHEELER
Title or Position: PARTNER
Credential: ARNP
Phone: 727-823-4848