Healthcare Provider Details

I. General information

NPI: 1770316333
Provider Name (Legal Business Name): 1ST STICK MOBILE MEDICAL SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2024
Last Update Date: 08/20/2024
Certification Date: 08/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

139 S PEBBLE BEACH BLVD STE 107
SUN CITY CENTER FL
33573-4711
US

IV. Provider business mailing address

139 S PEBBLE BEACH BLVD STE 107
SUN CITY CENTER FL
33573-4711
US

V. Phone/Fax

Practice location:
  • Phone: 813-296-3232
  • Fax: 813-213-9228
Mailing address:
  • Phone: 813-296-3232
  • Fax: 813-213-9228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ALFREDIA L WHITE
Title or Position: OWNER/ NURSE PRACTITIONER
Credential: APRN
Phone: 813-296-3232