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General NPI Number Information
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NPI Number | 1578991782
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Entity Type | Organization
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Legal Business Name | QWIKCARE INC
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Dates
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Enumeration Date | 10/25/2013
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Last Update Date | 10/25/2013
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Provider Practice Location Address
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Address Line | 4721 E MOODY BLVD SUITE 204
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City | BUNNELL
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State | FL
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Zip | 32110-7705
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Country | US
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Telephone | 386-864-0791
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Fax |
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Provider Business Mailing Address
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Address Line | 4721 E MOODY BLVD SUITE 204
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City | BUNNELL
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State | FL
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Zip | 32110-7705
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | VENUS VALLIERE
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Credential | ARNP
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Telephone | 386-864-0791
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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 | ARNP9265125
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License Number State | FL
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