Organization
RIVERS EDGE BOUTIQUE MEDICINE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TRACY GREENE NP-C (OWNER)
(727) 342-4955
Entity
Organization
Contact information
Practice address
5647 MAIN ST STE 1&2, NEW PORT RICHEY, FL 34652-2641
(727) 831-8376
Mailing address
5647 MAIN ST STE 1&2, NEW PORT RICHEY, FL 34652-2641
(727) 831-8376
Taxonomy
Speciality
Code
Description
License number
State
207QA0505X
Adult Medicine Physician
Primary
—
—
Other
Enumeration date
01/22/2024
Last updated
01/22/2024
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