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1366346843 NPI number — PREMIER FAMILY CARE CLINIC FLORIDA

NPI Number: 1366346843
Health Care Provider/Practitioner: PREMIER FAMILY CARE CLINIC FLORIDA

Information about “1366346843” NPI (PREMIER FAMILY CARE CLINIC FLORIDA) exists in 1366346843 in HTML format HTML  |  1366346843 in plain Text format TXT  |  1366346843 in PDF (Portable Document Format) PDF  |  1366346843 in an XML format XML  formats.

NPI Number : 1366346843 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1366346843",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "PREMIER FAMILY CARE CLINIC FLORIDA",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": "6",
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "55621 LOTTIE RD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "PERDIDO",
    "MailingAddressStateName": "AL",
    "MailingAddressPostalCode": "36562-3025",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "251-626-6757",
    "MailingAddressFaxNumber": "251-626-6758",
    "FirstLinePracticeLocationAddress": "2515 W HIGHWAY 4",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "CENTURY",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "32535-3503",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "251-626-6575",
    "PracticeLocationAddressFaxNumber": "251-626-6758",
    "EnumerationDate": "10/07/2026",
    "LastUpdateDate": "10/08/2026",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "LAMBETH",
    "AuthorizedOfficialFirstName": "KELLY",
    "AuthorizedOfficialMiddleName": "CAY",
    "AuthorizedOfficialTitle": "OWNER",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "CRNP",
    "AuthorizedOfficialTelephoneNumber": "251-626-6757",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "363LF0000X",
        "TaxonomyName": "Family Nurse Practitioner",
        "LicenseNumber": null,
        "LicenseNumberStateCode": "NULL",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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