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General NPI Number Information
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NPI Number | 1447540315
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Entity Type | Organization
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Legal Business Name | WE CARE FAMILY CLINIC INCORPORATED
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Dates
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Enumeration Date | 04/13/2011
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Last Update Date | 04/13/2011
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Provider Practice Location Address
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Address Line | 4410-12 W. OAKLAND PARK BLVD.
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City | LAUDERDALE LAKES
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State | FL
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Zip | 33313
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Country | US
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Telephone | 954-533-5900
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Fax |
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Provider Business Mailing Address
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Address Line | 4410-12 W. OAKLAND PARK BLVD.
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City | LAUDERDALE LAKES
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State | FL
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Zip | 33313
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Country | US
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Telephone | 954-533-5900
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CHRISTINA ANN-MARIE DAVIS-FOWLER
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Credential | PA-C
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Telephone | 954-533-5900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA9102369
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License Number State | FL
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