Provider Demographics
NPI:1386306983
Name:I-CARE VIRTUAL CLINIC LLC
Entity type:Organization
Organization Name:I-CARE VIRTUAL CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:APRN
Authorized Official - Prefix:
Authorized Official - First Name:KATIUSKA
Authorized Official - Middle Name:
Authorized Official - Last Name:MORENO
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:239-682-4874
Mailing Address - Street 1:690 WILSON BLVD S
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34117-9362
Mailing Address - Country:US
Mailing Address - Phone:239-682-4874
Mailing Address - Fax:
Practice Address - Street 1:690 WILSON BLVD S
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34117-9362
Practice Address - Country:US
Practice Address - Phone:239-682-4874
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-11
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care