Provider Demographics
NPI:1316691579
Name:OPTIMUM CARE CLINIC, LLC
Entity type:Organization
Organization Name:OPTIMUM CARE CLINIC, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:EDELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:DARDIGNAC
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:352-234-8612
Mailing Address - Street 1:614 E HWY 50
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-3164
Mailing Address - Country:US
Mailing Address - Phone:352-234-8612
Mailing Address - Fax:352-581-6903
Practice Address - Street 1:2642 EAGLE LAKE DR
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-6325
Practice Address - Country:US
Practice Address - Phone:352-234-8612
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-07
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care