NPIMap

Organization Active NPI

Equisential Primary Healthcare, LLC

  • Nurse Practitioner
  • Port St Lucie, FL
National Provider Identifier
1073155107
Registry record updated May 8, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
Legal business name
EQUISENTIAL PRIMARY HEALTHCARE, LLC
Practice address
2637 SW Import Dr
Port St Lucie, FL 34987-2056
Phone
(772) 342-3794
Fax
(772) 365-0456
NPI assigned
Oct 10, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 8, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Claudette Johnston-Creary, APRN
Title
Owner
Phone
(772) 342-3794

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse PractitionerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 363L00000X Primary

Addresses

Primary practice location

2637 SW Import Dr
Port St Lucie, FL 34987-2056

Mailing address

2637 SW Import Dr
Port St Lucie, FL 34987-2056
Phone (772) 342-3794

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1570665600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1588896000000",
    "number": "1073155107",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2637 SW IMPORT DR",
            "city": "PORT ST LUCIE",
            "state": "FL",
            "postal_code": "349872056",
            "telephone_number": "772-342-3794",
            "fax_number": "772-365-0456"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2637 SW IMPORT DR",
            "city": "PORT ST LUCIE",
            "state": "FL",
            "postal_code": "349872056",
            "telephone_number": "772-342-3794",
            "fax_number": "772-365-0456"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EQUISENTIAL PRIMARY HEALTHCARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-10-10",
        "last_updated": "2020-05-08",
        "certification_date": "2020-05-08",
        "status": "A",
        "authorized_official_last_name": "JOHNSTON-CREARY",
        "authorized_official_first_name": "CLAUDETTE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "772-342-3794",
        "authorized_official_credential": "APRN"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Port St Lucie, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.