Healthcare Provider Details

I. General information

NPI: 1104530294
Provider Name (Legal Business Name): HARBOUR MEDICAL CENTERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2023
Last Update Date: 01/12/2023
Certification Date: 01/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1411 SE OCEAN BLVD
STUART FL
34996-2651
US

IV. Provider business mailing address

1411 SE OCEAN BLVD
STUART FL
34996-2651
US

V. Phone/Fax

Practice location:
  • Phone: 772-781-1101
  • Fax: 772-781-1141
Mailing address:
  • Phone: 772-781-1101
  • Fax: 772-781-1141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MISS OLGA PURA VEIGA
Title or Position: BILLING/INSURANCE
Credential:
Phone: 772-781-1101