Provider Demographics
NPI:1548845456
Name:PALM FAMILY HEALTH LLC
Entity type:Organization
Organization Name:PALM FAMILY HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ANGELA
Authorized Official - Last Name:MCCARTHY
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:321-610-1017
Mailing Address - Street 1:1600 SARNO RD STE 21
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-4992
Mailing Address - Country:US
Mailing Address - Phone:321-610-1017
Mailing Address - Fax:321-610-7449
Practice Address - Street 1:1600 SARNO RD STE 21
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-4992
Practice Address - Country:US
Practice Address - Phone:321-610-1017
Practice Address - Fax:321-610-7449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-11
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLNP776OtherMEDICARE PTAN