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Organization
PREMIUM MEDICAL ASSOCIATES HEALTHCARE LLC
Active
Organization
PREMIUM MEDICAL ASSOCIATES HEALTHCARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LYNE PIERRE (BUSINESS PARTNER)
(407) 860-1511
Entity
Organization
Contact information
Practice address
600 W COLLEGE AVE, TALLAHASSEE, FL 32306-2808
(407) 498-6934
(407) 386-7878
Mailing address
4651 BABCOCK ST NE STE 18, PALM BAY, FL 32905-2808
(407) 498-6934
(407) 386-7878
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
—
NULL
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
NULL
364SP0808X
Psychiatric/Mental Health Clinical Nurse Specialist
—
NULL
364SP0808X
Psychiatric/Mental Health Clinical Nurse Specialist
—
—
Other
Enumeration date
06/10/2021
Last updated
06/10/2021
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