Provider Demographics
NPI:1982406112
Name:PURE HEALTH PRIMARY CARE CLINIC LLC
Entity type:Organization
Organization Name:PURE HEALTH PRIMARY CARE CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:DRENA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:HAYES
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:386-214-5611
Mailing Address - Street 1:2128 VALENCIA BLOSSOM ST
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-9576
Mailing Address - Country:US
Mailing Address - Phone:386-214-5611
Mailing Address - Fax:
Practice Address - Street 1:2128 VALENCIA BLOSSOM ST
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-9576
Practice Address - Country:US
Practice Address - Phone:386-214-5611
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-26
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care