Provider Demographics
NPI:1447715305
Name:MOTHER DAUGHTER PRIMARY CARE LLC
Entity type:Organization
Organization Name:MOTHER DAUGHTER PRIMARY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:APRN, FNP-BC
Authorized Official - Prefix:MS
Authorized Official - First Name:ANGELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-744-0020
Mailing Address - Street 1:10 FAIRWAY DR STE 305
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33441-1802
Mailing Address - Country:US
Mailing Address - Phone:954-744-0020
Mailing Address - Fax:754-318-6211
Practice Address - Street 1:10 FAIRWAY DR STE 305
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33441-1802
Practice Address - Country:US
Practice Address - Phone:954-744-0020
Practice Address - Fax:754-318-6211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-05
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty