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General NPI Number Information
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NPI Number | 1902051691
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Entity Type | Individual
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Provider Name | PRISCILLA ANN WEEMS RPT
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Gender | Female
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Dates
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Enumeration Date | 11/21/2008
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Last Update Date | 11/21/2008
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Provider Practice Location Address
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Address Line | 12577 SW 14TH ST
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City | DAVIE
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State | FL
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Zip | 33325-4411
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Country | US
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Telephone | 954-817-3375
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Fax | 954-475-4023
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Provider Business Mailing Address
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Address Line | 12577 SOUTHWEST 14TH STREET
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City | DAVIE
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State | FL
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Zip | 33325
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Country | US
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Telephone | 954-817-3375
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Fax | 954-475-4023
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number | PT1853
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License Number State | FL
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