Provider Demographics
NPI:1407675564
Name:NURSE KNACKS
Entity type:Organization
Organization Name:NURSE KNACKS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CAJUSTE
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:561-306-5343
Mailing Address - Street 1:6020 STRAWBERRY LAKES CIR
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33463-6509
Mailing Address - Country:US
Mailing Address - Phone:561-306-5343
Mailing Address - Fax:
Practice Address - Street 1:6020 STRAWBERRY LAKES CIR
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33463-6509
Practice Address - Country:US
Practice Address - Phone:561-306-5343
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-07
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty