Provider Demographics
NPI:1962089011
Name:PREMICE, CLAUDETTE (APRN)
Entity type:Individual
Prefix:
First Name:CLAUDETTE
Middle Name:
Last Name:PREMICE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4801 S UNIVERSITY DR STE 239
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33328-3836
Mailing Address - Country:US
Mailing Address - Phone:954-249-1984
Mailing Address - Fax:954-434-8711
Practice Address - Street 1:4801 S UNIVERSITY DR STE 239
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33328-3836
Practice Address - Country:US
Practice Address - Phone:954-249-1984
Practice Address - Fax:954-434-8711
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-25
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11011796363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health