Provider Demographics
NPI:1447540315
Name:WE CARE FAMILY CLINIC INCORPORATED
Entity type:Organization
Organization Name:WE CARE FAMILY CLINIC INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:ANN-MARIE
Authorized Official - Last Name:DAVIS-FOWLER
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:954-533-5900
Mailing Address - Street 1:4410-12 W. OAKLAND PARK BLVD.
Mailing Address - Street 2:
Mailing Address - City:LAUDERDALE LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33313
Mailing Address - Country:US
Mailing Address - Phone:954-533-5900
Mailing Address - Fax:
Practice Address - Street 1:4410-12 W. OAKLAND PARK BLVD.
Practice Address - Street 2:
Practice Address - City:LAUDERDALE LAKES
Practice Address - State:FL
Practice Address - Zip Code:33313
Practice Address - Country:US
Practice Address - Phone:954-533-5900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-13
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9102369363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL292343200Medicaid
FL292343200Medicaid
FLAA730ZMedicare Oscar/Certification