MEDICARE: PREMIER HEALTH PLUS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP2300X	Primary Care Nurse Practitioner

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	APRN9335689	OTHER	FL	LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043972102
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREMIER HEALTH PLUS LLC

Provider Business Mailing Address
First Line	:	3691 TAMIAMI TRL
Second Line	:
City	:	PUNTA GORDA
State	:	FL
Zip	:	33950-7228
Country	:	US
Telephone Number	:	941-347-8912
Fax Number	:

Provider Business Practice Location Address
First Line	:	3691 TAMIAMI TRL
Second Line	:
City	:	PUNTA GORDA
State	:	FL
Zip	:	33950-7228
Country	:	US
Telephone Number	:	941-347-8912
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JERRY G HERNANADEZ
Credential	:	APRN
Telephone Number	:	941-347-8912

Provider Enumeration Date	:	10/06/2021
Last Update Date	:	01/20/2022

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