Provider Demographics
NPI:1386327872
Name:PREMIER MOBILE MEDICAL CLINIC PLLC
Entity type:Organization
Organization Name:PREMIER MOBILE MEDICAL CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NADINE-ANNE
Authorized Official - Middle Name:ORINTHEA
Authorized Official - Last Name:SINGH
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:239-288-7949
Mailing Address - Street 1:10676 COLONIAL BLVD STE 20
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33913-8715
Mailing Address - Country:US
Mailing Address - Phone:239-288-7949
Mailing Address - Fax:239-208-3944
Practice Address - Street 1:10676 COLONIAL BLVD STE 20
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33913-8715
Practice Address - Country:US
Practice Address - Phone:239-288-7949
Practice Address - Fax:239-208-3944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-10
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty