Basic Information
Provider Information
NPI: 1467889535
EntityType: 2
ReplacementNPI:  
OrganizationName: ALLCARE CLINICAL ASSOCIATES, PA
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: FNP
OtherOrganizationType: 5
OtherLastName:  
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Mailing Information
Address1: 4919 MEMORIAL HWY STE 200
Address2:  
City: TAMPA
State: FL
PostalCode: 336347500
CountryCode: US
TelephoneNumber: 8666317890
FaxNumber:  
Practice Location
Address1: 76 PEACHTREE ROAD
Address2: SUITE 300
City: ASHEVILLE
State: NC
PostalCode: 288033505
CountryCode: US
TelephoneNumber: 8282743477
FaxNumber: 8282747407
Other Information
ProviderEnumerationDate: 10/03/2013
LastUpdateDate: 12/20/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: BALDOCK
AuthorizedOfficialFirstName: JENNIFER
AuthorizedOfficialMiddleName: BOYD
AuthorizedOfficialTitleorPosition: OFFICER AND AUTHORIZED OFFICIAL
AuthorizedOfficialTelephone: 6152345900
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
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AuthorizedOfficialCredential:  
NPICertificationDate: 12/20/2019

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000X  Y193400000X MULTIPLE SINGLE SPECIALTY GROUPPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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