ST.PETE NURSE PRACTITIONER LLC NPI 1720724297

NPI Information

NPI: 1720724297
Provider Name: ST.PETE NURSE PRACTITIONER, LLC
Classification: Clinic/Center - 261QP2300X
Entity Type: Organization

Specialization: Primary Care

CLIA Number: 10D2263743

Address:
33 4TH ST N STE 202
SAINT PETERSBURG, FL
ZIP 33701
Phone: (727) 686-8284
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ST.PETE NURSE PRACTITIONER, LLC is a primary care clinic center in Saint Petersburg, FL. ST.PETE NURSE PRACTITIONER, LLC NPI is 1720724297. The provider is registered as an organization entity type.

The provider's business location address is:

33 4TH ST N STE 202
SAINT PETERSBURG, FL
ZIP 33701-806
Phone: (727) 686-8284

The provider's authorized official is Jessica Caraballo .
The authorized official title is President and has the following contact phone number (727) 686-8284.

The CLIA number assigned to this NPI record is 10D2263743 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 5/9/2022 and was last updated on 5/9/2022.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QP2300X	Clinic/Center	Primary Care			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	1437649100	MEDICAID	FLORIDA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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