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General NPI Number Information
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NPI Number | 1730715897
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Entity Type | Organization
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Legal Business Name | INTEGRATED PRIMARY CARE & PSYCH MENTAL HEALTH LLC
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Dates
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Enumeration Date | 03/19/2020
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Last Update Date | 08/10/2021
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Provider Practice Location Address
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Address Line | 4300 N UNIVERSITY DR STE C103
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City | SUNRISE
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State | FL
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Zip | 33351-6243
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Country | US
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Telephone | 954-478-5763
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Fax | 954-901-2713
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Provider Business Mailing Address
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Address Line | 4300 N UNIVERSITY DR STE C103
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City | SUNRISE
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State | FL
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Zip | 33351-6243
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Country | US
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Telephone | 954-478-5763
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Fax | 954-901-2713
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | NICOLAS EMANUEL AQUINO-MUNOZ
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Credential |
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Telephone | 954-667-4186
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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 |
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License Number State |
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Taxonomy #2
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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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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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