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General NPI Number Information
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NPI Number | 1790541456
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Entity Type | Organization
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Legal Business Name | PRIMARY CARE OF OC LLC
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Dates
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Enumeration Date | 02/21/2024
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Last Update Date | 02/21/2024
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Provider Practice Location Address
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Address Line | 135 E MINNESOTA AVE
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City | ORANGE CITY
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State | FL
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Zip | 32763-2312
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Country | US
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Telephone | 386-316-5439
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Fax | 833-671-1039
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Provider Business Mailing Address
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Address Line | 341 W MINNESOTA AVE
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City | ORANGE CITY
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State | FL
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Zip | 32763-2205
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | VALMA CROKER
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Credential |
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Telephone | 386-214-8047
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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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