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General NPI Number Information
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NPI Number | 1720656523
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Entity Type | Organization
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Legal Business Name | PRIMARY CARE AT HOME OF FLORIDA PLLC
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Dates
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Enumeration Date | 06/16/2021
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Last Update Date | 09/29/2021
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Provider Practice Location Address
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Address Line | 5949 NW 24TH CT
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City | MARGATE
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State | FL
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Zip | 33063-1952
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Country | US
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Telephone | 954-621-8980
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Fax |
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Provider Business Mailing Address
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Address Line | 6295 W SAMPLE RD UNIT 670783
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City | CORAL SPRINGS
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State | FL
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Zip | 33067-5142
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Country | US
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Telephone | 954-621-8980
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Fax |
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Authorized Official
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Title or Position | DNP
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Name | DR. JASON CHARLES CARDILLO
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Credential |
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Telephone | 813-368-5494
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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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