Provider Demographics
NPI:1598400467
Name:SOUTH FLORIDA PSYCH AND INTEGRATED CARE CONCIERGE, LLC
Entity type:Organization
Organization Name:SOUTH FLORIDA PSYCH AND INTEGRATED CARE CONCIERGE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YVELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:JACQUES
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:561-337-0210
Mailing Address - Street 1:6100 GLADES RD STE 311
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33434-4325
Mailing Address - Country:US
Mailing Address - Phone:561-931-0381
Mailing Address - Fax:561-264-3153
Practice Address - Street 1:6100 GLADES RD STE 311
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33434-4325
Practice Address - Country:US
Practice Address - Phone:561-931-0381
Practice Address - Fax:561-264-3153
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-04
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty