MEDICARE: NEIGHBORHOOD NURSE CLINICS 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	363L00000X	Nurse Practitioner
2	363LP2300X	Primary Care Nurse Practitioner

General Provider Information

NPI Number	:	1639812944
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEIGHBORHOOD NURSE CLINICS LLC

Provider Business Mailing Address
First Line	:	2717 YACHT CLUB BLVD APT 5C
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33304-4517
Country	:	US
Telephone Number	:	404-702-8761
Fax Number	:

Provider Business Practice Location Address
First Line	:	2717 YACHT CLUB BLVD APT 5C
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33304-4517
Country	:	US
Telephone Number	:	404-702-8761
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KRISTINA LARSEN
Credential	:
Telephone Number	:	404-702-8761

Provider Enumeration Date	:	04/14/2022
Last Update Date	:	04/14/2022

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