Organization Name: | HANDS OF ST. LUCIE COUNTY |
NPI Number: | 1144570748 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | CHRISTIANA SELPH (OFFICE MANAGER) |
Mailing Address: | 3079 Sw Lucerne St. Port St. Lucie |
State: | FL US |
Postal Code: | 34953 |
Phone Number: | 7724632453 |
Fax Number: | |
NPI Enumeration Date: | 09/12/2012 |
NPI Last Update Date: | 09/12/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | ARNP9226579 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |