Organization
FLORIDA ATLANTIC UNIVERSITY
Active
Other names
COMMUNITY HEALTH CENTER
Organization subpart
No
Provider details
NPI number
Authorized official
LOUISA PONTIROLI KELLY (AUTHORIZED OFFICIAL)
(561) 803-8880
Entity
Organization
Contact information
Practice address
720 8TH ST, WEST PALM BEACH, FL 33401-3606
(561) 803-8880
(877) 409-1795
Mailing address
720 8TH ST, WEST PALM BEACH, FL 33401-3606
(561) 803-8880
(877) 409-1795
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
363L00000X
Nurse Practitioner
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
364SS0200X
School Clinical Nurse Specialist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
002Z8
BCBS
FL
05
—
127082701
—
FL
01
—
C111027
FQHC-MEDICARE
FL
01
—
K3331C
FQHC-MEDICARE
FL
Enumeration date
07/15/2010
Last updated
12/15/2025
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