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General NPI Number Information
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NPI Number | 1043835903
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Entity Type | Organization
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Legal Business Name | HONOR MOBILE HEALTHCARE PLLC
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Dates
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Enumeration Date | 06/16/2020
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Last Update Date | 06/19/2020
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Provider Practice Location Address
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Address Line | 7786 RIDGELAKE CIR
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City | BRADENTON
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State | FL
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Zip | 34203-2509
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Country | US
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Telephone | 941-828-5199
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Fax | 941-761-6188
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Provider Business Mailing Address
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Address Line | 7786 RIDGELAKE CIR
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City | BRADENTON
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State | FL
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Zip | 34203-2509
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Country | US
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Telephone | 941-828-5199
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Fax | 941-761-6188
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Authorized Official
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Title or Position | OWNER
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Name | KRIS JOANN MINKO
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Credential | APRN
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Telephone | 608-206-5479
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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