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Organization
LONGEVITY CLINICAL LTC ASSOCIATES OF FLORIDA PLLC
Active
Organization
LONGEVITY CLINICAL LTC ASSOCIATES OF FLORIDA PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DIANE VINCUR (CLINICAL SUPPORT TALENT SPECIALIST)
(561) 815-2427
Entity
Organization
Contact information
Practice address
4300 ROCK ISLAND RD, LAUDERHILL, FL 33319-4528
(954) 485-6144
Mailing address
11770 US 1, PALM BEACH GARDENS, FL 33408-3027
(561) 815-2427
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
NULL
207Q00000X
Family Medicine Physician
—
—
207QG0300X
Geriatric Medicine (Family Medicine) Physician
—
NULL
207QG0300X
Geriatric Medicine (Family Medicine) Physician
—
—
363LG0600X
Gerontology Nurse Practitioner
—
NULL
363LG0600X
Gerontology Nurse Practitioner
—
—
363LP2300X
Primary Care Nurse Practitioner
Primary
—
NULL
363LP2300X
Primary Care Nurse Practitioner
Primary
—
—
Other
Enumeration date
05/13/2021
Last updated
05/14/2021
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