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General NPI Number Information
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NPI Number | 1063164226
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Entity Type | Organization
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Legal Business Name | PARK PLACE MEDICAL, LLC
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Dates
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Enumeration Date | 01/19/2022
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Last Update Date | 01/19/2022
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Provider Practice Location Address
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Address Line | 1800 PEMBROOK DR STE 300
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City | ORLANDO
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State | FL
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Zip | 32810-6378
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Country | US
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Telephone | 407-712-0514
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Fax |
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Provider Business Mailing Address
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Address Line | 1800 PEMBROOK DR STE 300
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City | ORLANDO
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State | FL
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Zip | 32810-6378
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Country | US
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Telephone | 407-712-0514
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MS. EMMA ZAINABU SANDI
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Credential | ARNP
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Telephone | 407-712-0514
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number |
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License Number State |
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Taxonomy #3
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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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