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General NPI Number Information
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NPI Number | 1790453041
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Entity Type | Organization
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Legal Business Name | COMPASSIONATE CARE PRIMARY SERVICE
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Dates
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Enumeration Date | 09/01/2021
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Last Update Date | 02/20/2023
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Provider Practice Location Address
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Address Line | 18490 NE 76TH LN
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City | WILLISTON
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State | FL
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Zip | 32696-3810
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Country | US
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Telephone | 352-284-4095
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Fax | 641-323-5203
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Provider Business Mailing Address
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Address Line | 18490 NE 76TH LN
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City | WILLISTON
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State | FL
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Zip | 32696-3810
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Country | US
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Telephone | 352-284-4095
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Fax | 641-323-5203
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | MRS. DIRONADA GROSS STRANGE
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Credential | APRN
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Telephone | 352-284-4095
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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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