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General NPI Number Information
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NPI Number | 1922753508
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Entity Type | Organization
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Legal Business Name | PRIMARY ONE HEALTHCARE PLLC
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Dates
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Enumeration Date | 02/13/2022
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Last Update Date | 02/15/2022
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Provider Practice Location Address
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Address Line | 433 PLAZA REAL STE 275
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City | BOCA RATON
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State | FL
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Zip | 33432-3999
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Country | US
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Telephone | 561-332-4545
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Fax | 888-726-9869
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Provider Business Mailing Address
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Address Line | 433 PLAZA REAL STE 275
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City | BOCA RATON
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State | FL
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Zip | 33432-3999
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Country | US
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Telephone | 561-332-4545
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Fax | 888-726-9869
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Authorized Official
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Title or Position | CO-OWNER
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Name | VICKY PAUL
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Credential | APRN
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Telephone | 561-332-4545
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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