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General NPI Number Information
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NPI Number | 1518564699
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Entity Type | Organization
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Legal Business Name | PREMIER CARE CENTRE LLC
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Dates
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Enumeration Date | 10/02/2020
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Last Update Date | 09/15/2023
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Provider Practice Location Address
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Address Line | 2050 HAVENDALE BLVD NW STE B
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City | WINTER HAVEN
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State | FL
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Zip | 33881-3828
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Country | US
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Telephone | 863-268-2211
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Fax | 863-222-9343
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Provider Business Mailing Address
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Address Line | 2050 HAVENDALE BLVD NW STE B
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City | WINTER HAVEN
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State | FL
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Zip | 33881-3828
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Country | US
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Telephone | 863-268-2211
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Fax | 863-222-9343
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Authorized Official
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Title or Position | DNP, APRN
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Name | CHRISTA LORGEAT
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Credential |
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Telephone | 863-250-7260
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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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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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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