# PREMIER LIFE HEALTH SERVICES, LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Other names:** Premier Healthcare of Florida
- **Organization subpart:** No

## Provider details

- **NPI number:** 1417180043
- **Authorized official:** DR. KETTY MAURICE D.O. (PRESIDENT)
- **Authorized official phone:** (407) 892-3627

## Contact information

- **Practice address:** 4737 OLD CANOE CREEK ROAD, SAINT CLOUD, FL 34769-0000
- **Practice address phone:** (407) 892-3627
- **Practice address fax:** (407) 892-3625
- **Mailing address:** PO BOX 702382, SAINT CLOUD, FL 34770-2382
- **Mailing address phone:** (407) 892-3627
- **Mailing address fax:** (407) 892-3625

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 08/31/2009
- **Last updated:** 09/24/2009