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General NPI Number Information
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NPI Number | 1720746951
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Entity Type | Organization
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Legal Business Name | SOUTH PALM FAMILY CENTER
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Dates
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Enumeration Date | 12/06/2021
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Last Update Date | 09/06/2023
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Provider Practice Location Address
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Address Line | 1701 SE HILLMOOR DR STE B9
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34952-7540
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Country | US
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Telephone | 772-348-0303
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Fax |
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Provider Business Mailing Address
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Address Line | 1701 SE HILLMOOR DR STE B9
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34952-7540
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Country | US
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Telephone | 772-348-0303
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DR. JUDITH C BROOKS
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Credential | MD
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Telephone | 772-348-0303
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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