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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
261QM1300X
Multi-Specialty Clinic/Center
Primary
364SP0808X
Psychiatric/Mental Health Clinical Nurse Specialist

Other

Enumeration date
06/10/2021
Last updated
06/10/2021
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