Provider Demographics
NPI:1427876911
Name:ADVANTAGE HEALTH PRIMARY CARE LLC
Entity type:Organization
Organization Name:ADVANTAGE HEALTH PRIMARY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:DANIELS
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, APRN, FNP-C
Authorized Official - Phone:337-202-1020
Mailing Address - Street 1:906 N PINE ST STE A
Mailing Address - Street 2:
Mailing Address - City:DERIDDER
Mailing Address - State:LA
Mailing Address - Zip Code:70634-2816
Mailing Address - Country:US
Mailing Address - Phone:337-202-1020
Mailing Address - Fax:
Practice Address - Street 1:906 N PINE ST STE A
Practice Address - Street 2:
Practice Address - City:DERIDDER
Practice Address - State:LA
Practice Address - Zip Code:70634-2816
Practice Address - Country:US
Practice Address - Phone:337-202-1020
Practice Address - Fax:337-221-1160
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADVANTAGE HEALTH URGENT CARE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-10-02
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty