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General NPI Number Information
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NPI Number | 1295369833
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Entity Type | Organization
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Legal Business Name | PRIORITY HEALTHCARE SERVICES LLC
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Dates
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Enumeration Date | 02/22/2020
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Last Update Date | 02/22/2020
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Provider Practice Location Address
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Address Line | 15901 SW 61ST ST
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City | DAVIE
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State | FL
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Zip | 33331-3405
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Country | US
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Telephone | 954-665-6766
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Fax |
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Provider Business Mailing Address
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Address Line | 15901 SW 61ST ST
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City | DAVIE
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State | FL
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Zip | 33331-3405
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Country | US
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Telephone | 954-665-6766
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER(OWNER)
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Name | MRS. SHERYL MARGARITA RAIKES
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Credential | APRN
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Telephone | 954-665-6766
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number |
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License Number State |
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