1023405610 NPI number — PRINCIPLE HEALTHCARE GROUP, LLC.

Table of content: MS. ANNIE ALBERTA WICKHAM CRNA (NPI 1780749192)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023405610 NPI number — PRINCIPLE HEALTHCARE GROUP, LLC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRINCIPLE HEALTHCARE GROUP, LLC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1023405610
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/21/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 144131
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CORAL GABLES
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33114-4131
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-932-6600
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7208 N STERLING AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TAMPA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33614-4228
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-932-6600
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/21/2015

Additional Information

Authorized Official

Authorized Official Last Name:
QUIRANTES
Authorized Official First Name:
RAMON
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICER
Authorized Official Telephone Number:
305-898-7065

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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