Basic Information
| Provider Information | |||||||||
| NPI: | 1104436492 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CARETINUUM HEALTH, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | CARETINUUM HEALTH | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 151 ANCONA AVE | ||||||||
| Address2: | |||||||||
| City: | DEBARY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327135403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4073615785 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3208 W LAKE MARY BLVD STE 1710 | ||||||||
| Address2: | |||||||||
| City: | LAKE MARY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327463467 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4073615785 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/03/2020 | ||||||||
| LastUpdateDate: | 01/27/2022 | ||||||||
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| AuthorizedOfficialLastName: | BURGESS | ||||||||
| AuthorizedOfficialFirstName: | MEAGAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | CO-FOUNDER; APRN | ||||||||
| AuthorizedOfficialTelephone: | 4073615785 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | APRN | ||||||||
| NPICertificationDate: | 01/27/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2300X | N | Ambulatory Health Care Facilities | Clinic/Center | Primary Care | 363LF0000X | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.