MEDICARE: SLC ADVANCED PRACTICE 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	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1578414553
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SLC ADVANCED PRACTICE LLC

Provider Business Mailing Address
First Line	:	1812 HAZELWOOD DR
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34982-6579
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1812 HAZELWOOD DR
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34982-6579
Country	:	US
Telephone Number	:	772-874-3269
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SARA CRAFT
Credential	:	APRN
Telephone Number	:	772-321-8323

Provider Enumeration Date	:	02/05/2026
Last Update Date	:	02/05/2026

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Directions to “SLC ADVANCED PRACTICE LLC ” Practice Location

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