| Sparkle Care Family Health Np Pllc | |
|
25 Nicoll Ave Central Islip NY 11722-3136 | |
| (631) 605-4089 | |
| Not Available |
| Full Name | Sparkle Care Family Health Np Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 25 Nicoll Ave, Central Islip, New York |
| Authorized Official Name and Position | Takeisha Judkins (DIRECTOR) |
| Authorized Official Contact | 6316054089 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sparkle Care Family Health Np Pllc 25 Nicoll Ave Central Islip NY 11722-3136 Ph: (631) 605-4089 | Sparkle Care Family Health Np Pllc 25 Nicoll Ave Central Islip NY 11722-3136 Ph: (631) 605-4089 |
| NPI Number | 1831892462 |
|---|---|
| Provider Enumeration Date | 03/23/2023 |
| Last Update Date | 03/23/2023 |
| Medicare PECOS PAC ID | 2264878198 |
|---|---|
| Medicare Enrollment ID | O20240313002547 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1831892462 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Takeisha Judkins |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1891066429 PECOS PAC ID: 6305234964 Enrollment ID: I20211101001801 |
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