Basic Information
| Provider Information | |||||||||
| NPI: | 1386306983 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | I-CARE VIRTUAL CLINIC LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 690 WILSON BLVD S | ||||||||
| Address2: | |||||||||
| City: | NAPLES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 341179362 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2396824874 | ||||||||
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| Practice Location | |||||||||
| Address1: | 690 WILSON BLVD S | ||||||||
| Address2: | |||||||||
| City: | NAPLES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 341179362 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2396824874 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/11/2021 | ||||||||
| LastUpdateDate: | 10/11/2021 | ||||||||
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| AuthorizedOfficialLastName: | MORENO | ||||||||
| AuthorizedOfficialFirstName: | KATIUSKA | ||||||||
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| AuthorizedOfficialTitleorPosition: | APRN | ||||||||
| AuthorizedOfficialTelephone: | 2396824874 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | ARNP | ||||||||
| NPICertificationDate: | 10/11/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Primary Care |
No ID Information.