=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952980062
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | XSPURT PROVIDER SERVICES, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/06/2021
-----------------------------------------------------
Last Update Date | 04/06/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6283 NW 201ST TER STE 2A
-----------------------------------------------------
City | HIALEAH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33015-2194
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-223-0386
-----------------------------------------------------
Fax | 305-624-7285
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6283 NW 201ST TER STE 2A
-----------------------------------------------------
City | HIALEAH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33015-2194
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-863-4915
-----------------------------------------------------
Fax | 305-624-7285
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT AND DIRECTOR
-----------------------------------------------------
Name | DR. LINDA JOYCE WASHINGTON-BROWN
-----------------------------------------------------
Credential | APRN
-----------------------------------------------------
Telephone | 786-223-0386
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------