IMPACT PRACTITIONER SERVICES LLC NPI 1982457081

NPI Information

  • NPI: 1982457081
  • Provider Name: IMPACT PRACTITIONER SERVICES, LLC
  • Classification: Nurse Practitioner - 363LP2300X
  • Specialization: Primary Care
  • Entity Type: Organization
  • CLIA Number: 10D2307919
  • Address: 3307 N INDIAN RIVER DR
    FORT PIERCE, FL
    ZIP 34946
  • Phone: (772) 528-5991

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NPI Details

IMPACT PRACTITIONER SERVICES, LLC is a primary care nurse practitioner in Fort Pierce, FL. IMPACT PRACTITIONER SERVICES, LLC NPI is 1982457081. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

3307 N INDIAN RIVER DR
FORT PIERCE, FL
ZIP 34946-418
Phone: (772) 528-5991

The provider's authorized official is Kelli Kraaz .
The authorized official title is Sole Propietor and has the following contact phone number (772) 528-5991.

The CLIA number assigned to this NPI record is 10D2307919 - mobile laboratory with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 4/9/2024 and was last updated on 4/9/2024.

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
1363LP2300XNurse PractitionerPrimary CareYes

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: 11/21/2025

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