Provider Demographics
NPI:1316320591
Name:CHANGES FAMILY PRACTICE CLINIC
Entity type:Organization
Organization Name:CHANGES FAMILY PRACTICE CLINIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:D
Authorized Official - Last Name:ENGRAM
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:561-899-9140
Mailing Address - Street 1:1531 W 12TH ST
Mailing Address - Street 2:
Mailing Address - City:RIVIERA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33404-6512
Mailing Address - Country:US
Mailing Address - Phone:561-899-9140
Mailing Address - Fax:561-331-2715
Practice Address - Street 1:31 W 20TH ST
Practice Address - Street 2:
Practice Address - City:RIVIERA BEACH
Practice Address - State:FL
Practice Address - Zip Code:33404-6155
Practice Address - Country:US
Practice Address - Phone:561-899-9140
Practice Address - Fax:561-331-2715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-07
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty