Organization
LONGEVITY CLINICAL LTC ASSOCIATES OF FLORIDA PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DIANE VINCUR (CLINICAL SUPPORT TALENT SPECIALIST)
(561) 815-2427
Entity
Organization
Contact information
Practice address
4300 ROCK ISLAND RD, LAUDERHILL, FL 33319-4528
(954) 485-6144
Mailing address
11770 US 1, PALM BEACH GARDENS, FL 33408-3027
(561) 815-2427
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207QG0300X
Geriatric Medicine (Family Medicine) Physician
—
—
363LG0600X
Gerontology Nurse Practitioner
—
—
363LP2300X
Primary Care Nurse Practitioner
Primary
—
—
Other
Enumeration date
05/13/2021
Last updated
05/14/2021
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