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General NPI Number Information
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NPI Number | 1720724297
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Entity Type | Organization
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Legal Business Name | ST.PETE NURSE PRACTITIONER, LLC
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Dates
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Enumeration Date | 05/09/2022
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Last Update Date | 05/09/2022
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Provider Practice Location Address
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Address Line | 33 4TH ST N STE 202
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City | SAINT PETERSBURG
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State | FL
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Zip | 33701-3806
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Country | US
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Telephone | 727-686-8284
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Fax |
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Provider Business Mailing Address
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Address Line | 4670 CHANCELLOR ST NE
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City | SAINT PETERSBURG
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State | FL
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Zip | 33703-4345
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Country | US
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Telephone | 727-686-8284
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JESSICA CARABALLO
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Credential | ARNP
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Telephone | 727-686-8284
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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