Provider Demographics
NPI:1528626587
Name:FAMILY FIRST DIRECT PRIMARY CARE LLC
Entity type:Organization
Organization Name:FAMILY FIRST DIRECT PRIMARY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:LASHUNDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BLACKSHEAR
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:561-667-9216
Mailing Address - Street 1:538 CYPRESS DR
Mailing Address - Street 2:
Mailing Address - City:LAKE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33403-3335
Mailing Address - Country:US
Mailing Address - Phone:561-667-9216
Mailing Address - Fax:
Practice Address - Street 1:2247 PALM BEACH LAKES BLVD STE 206
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33409-3413
Practice Address - Country:US
Practice Address - Phone:561-667-9216
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FAMILY FIRST DIRECT PRIMARY CARE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-06-04
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty