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General NPI Number Information
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NPI Number | 1528626587
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Entity Type | Organization
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Legal Business Name | FAMILY FIRST DIRECT PRIMARY CARE LLC
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Dates
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Enumeration Date | 06/04/2019
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Last Update Date | 09/13/2023
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Provider Practice Location Address
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Address Line | 2247 PALM BEACH LAKES BLVD STE 206
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City | WEST PALM BEACH
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State | FL
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Zip | 33409-3413
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Country | US
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Telephone | 561-667-9216
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Fax |
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Provider Business Mailing Address
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Address Line | 538 CYPRESS DR
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City | LAKE PARK
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State | FL
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Zip | 33403-3335
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Country | US
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Telephone | 561-667-9216
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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 | LASHUNDA BLACKSHEAR
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Credential | APRN
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Telephone | 561-667-9216
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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