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General NPI Number Information
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NPI Number | 1558035352
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Entity Type | Organization
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Legal Business Name | PRIMARY AND TRANSITIONAL CARE SERVICE
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Dates
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Enumeration Date | 08/04/2021
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Last Update Date | 08/04/2021
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Provider Practice Location Address
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Address Line | 1501 11TH ST
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City | WEST PALM BEACH
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State | FL
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Zip | 33401-3038
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Country | US
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Telephone | 561-537-9028
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Fax |
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Provider Business Mailing Address
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Address Line | 1501 11TH ST
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City | WEST PALM BEACH
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State | FL
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Zip | 33401-3038
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Country | US
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Telephone | 561-537-9028
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Fax |
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Authorized Official
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Title or Position | APRN
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Name | KENOL CICERON
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Credential | FNP
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Telephone | 561-537-9028
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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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