# INTEGRATED PRIMARY CARE & PSYCH MENTAL HEALTH LLC

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

## Provider details

- **NPI number:** 1730715897
- **Authorized official:** NICOLAS EMANUEL AQUINO-MUNOZ (CHIEF EXECUTIVE OFFICER)
- **Authorized official phone:** (954) 667-4186

## Contact information

- **Practice address:** 4300 N UNIVERSITY DR STE C103, SUNRISE, FL 33351-6243
- **Practice address phone:** (954) 478-5763
- **Practice address fax:** (954) 901-2713
- **Mailing address:** 4300 N UNIVERSITY DR STE C103, SUNRISE, FL 33351-6243
- **Mailing address phone:** (954) 478-5763
- **Mailing address fax:** (954) 901-2713

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LF0000X | Family Nurse Practitioner | — | NULL | — |
| 363LF0000X | Family Nurse Practitioner | — | — | — |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | NULL | Yes |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | Yes |
| 363LP2300X | Primary Care Nurse Practitioner | — | NULL | — |
| 363LP2300X | Primary Care Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 03/19/2020
- **Last updated:** 08/10/2021