# LONGEVITY CLINICAL LTC ASSOCIATES OF FLORIDA PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1639743750
- **Authorized official:** DIANE VINCUR (CLINICAL SUPPORT TALENT SPECIALIST)
- **Authorized official phone:** (561) 815-2427

## Contact information

- **Practice address:** 4300 ROCK ISLAND RD, LAUDERHILL, FL 33319-4528
- **Practice address phone:** (954) 485-6144
- **Mailing address:** 11770 US 1, PALM BEACH GARDENS, FL 33408-3027
- **Mailing address phone:** (561) 815-2427

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 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 | — | NULL | Yes |
| 363LP2300X | Primary Care Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 05/13/2021
- **Last updated:** 05/14/2021