Provider Demographics
NPI:1699063388
Name:DACRIS PRACTITIONER SERCICES INC
Entity type:Organization
Organization Name:DACRIS PRACTITIONER SERCICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MISS
Authorized Official - First Name:LLUDIVINA
Authorized Official - Middle Name:
Authorized Official - Last Name:VIGIL
Authorized Official - Suffix:
Authorized Official - Credentials:ANP-BC
Authorized Official - Phone:305-279-8187
Mailing Address - Street 1:10651 N KENDALL DR
Mailing Address - Street 2:STE 117
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-1569
Mailing Address - Country:US
Mailing Address - Phone:305-279-8187
Mailing Address - Fax:305-279-8194
Practice Address - Street 1:10651 N KENDALL DR
Practice Address - Street 2:STE 117
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-1569
Practice Address - Country:US
Practice Address - Phone:305-279-8187
Practice Address - Fax:305-279-8194
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-14
Last Update Date:2011-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9229298163WX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WX0200XNursing Service ProvidersRegistered NurseOncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL9229298OtherANP LICENSE