| Prime Health Of North Port Llc | |
|
2975 Bobcat Village Center Rd Suite 100 North Port FL 34288-4600 | |
| (941) 423-9936 | |
| (941) 426-9794 |
| Full Name | Prime Health Of North Port Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 2975 Bobcat Village Center Rd, North Port, Florida |
| Authorized Official Name and Position | Lee Gross (OWNER) |
| Authorized Official Contact | 9414239936 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Prime Health Of North Port Llc 2975 Bobcat Village Center Rd Suite 100 North Port FL 34288-4600 Ph: (941) 423-9936 | Prime Health Of North Port Llc 2975 Bobcat Village Center Rd Suite 100 North Port FL 34288-4600 Ph: (941) 423-9936 |
| NPI Number | 1740228386 |
|---|---|
| Provider Enumeration Date | 06/04/2006 |
| Last Update Date | 09/27/2011 |
| Medicare PECOS PAC ID | 5890776751 |
|---|---|
| Medicare Enrollment ID | O20040526001075 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1740228386 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | ME84648 (Florida) | Primary |
| Provider Name | Candice D Martens Nicoll |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669798641 PECOS PAC ID: 3274704465 Enrollment ID: I20110920000288 |
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