Provider Demographics
NPI:1760009138
Name:CONCIERGE PRIMARY CARE LLC
Entity type:Organization
Organization Name:CONCIERGE PRIMARY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMSON
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:954-501-3861
Mailing Address - Street 1:7050 W PALMETTO PARK RD # 15-513
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-3426
Mailing Address - Country:US
Mailing Address - Phone:954-501-3861
Mailing Address - Fax:
Practice Address - Street 1:9500 NW 49TH CT
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33076-2465
Practice Address - Country:US
Practice Address - Phone:954-501-3861
Practice Address - Fax:608-305-8874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-01
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty