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General NPI Number Information
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NPI Number | 1336835404
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Entity Type | Organization
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Legal Business Name | FULL CIRCLE CARE PLLC
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Dates
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Enumeration Date | 04/12/2023
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Last Update Date | 04/20/2024
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Provider Practice Location Address
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Address Line | 2110 E FLAMINGO RD STE 105
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City | LAS VEGAS
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State | NV
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Zip | 89119-5191
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Country | US
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Telephone | 702-695-2084
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Fax | 702-537-0981
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Provider Business Mailing Address
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Address Line | 2110 E FLAMINGO RD STE 105
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City | LAS VEGAS
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State | NV
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Zip | 89119-5191
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Country | US
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Telephone | 702-695-2084
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | MRS. JENNIFER ELIZABETH STORY-SALACUP
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Credential | APRN
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Telephone | 702-513-5533
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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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 | 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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