Healthcare Provider Details

I. General information

NPI: 1689808354
Provider Name (Legal Business Name): TEQUESTA PRIMARY CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2009
Last Update Date: 05/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MAIN ST STE 102
TEQUESTA FL
33469-4710
US

IV. Provider business mailing address

1 MAIN ST STE 102
TEQUESTA FL
33469-4710
US

V. Phone/Fax

Practice location:
  • Phone: 561-747-4464
  • Fax: 561-747-5598
Mailing address:
  • Phone: 561-747-4464
  • Fax: 561-747-5598

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: SYLVIE A RIMMER
Title or Position: CLINICAL DIRECTOR
Credential: MD
Phone: 561-747-4464