Provider Demographics
NPI:1609698802
Name:JUST CARE NURSE PRACTITIONER IN FAMILY HEALTH PRACTICE PLLC
Entity type:Organization
Organization Name:JUST CARE NURSE PRACTITIONER IN FAMILY HEALTH PRACTICE PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:STAPLE
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:718-362-1411
Mailing Address - Street 1:34 CROMER RD E
Mailing Address - Street 2:
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-4825
Mailing Address - Country:US
Mailing Address - Phone:718-570-2057
Mailing Address - Fax:360-282-0789
Practice Address - Street 1:34 CROMER RD E
Practice Address - Street 2:
Practice Address - City:ELMONT
Practice Address - State:NY
Practice Address - Zip Code:11003-4825
Practice Address - Country:US
Practice Address - Phone:718-570-2057
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-29
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty