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General NPI Number Information
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NPI Number | 1336901024
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Entity Type | Organization
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Legal Business Name | THE DOCTOR NURSE FOR HEALTHY AGING LLC
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Dates
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Enumeration Date | 01/29/2024
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Last Update Date | 05/06/2024
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Provider Practice Location Address
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Address Line | 777 GLADES RD BLDG AZ-79
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City | BOCA RATON
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State | FL
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Zip | 33431-6496
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Country | US
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Telephone | 561-297-0502
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Fax | 561-297-0505
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Provider Business Mailing Address
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Address Line | 21575 KAPOK CIR
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City | BOCA RATON
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State | FL
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Zip | 33433-3718
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Country | US
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Telephone | 561-462-0622
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Fax | 561-287-8092
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Authorized Official
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Title or Position | PRIMARY CARE PROVIDER
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Name | DR. ALICE W BRUMLEY
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Credential | DNP
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Telephone | 561-462-0622
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology 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 | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number |
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License Number State |
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