NPIMap

Organization Active NPI

Longevity Clinical LTC Associates of Florida PLLC

  • Primary Care Nurse Practitioner
  • Lauderhill, FL
National Provider Identifier
1639743750
Registry record updated May 14, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Nurse PractitionerTaxonomy code 363LP2300X
Legal business name
LONGEVITY CLINICAL LTC ASSOCIATES OF FLORIDA PLLC
Practice address
4300 Rock Island Rd
Lauderhill, FL 33319-4528
Phone
(954) 485-6144
NPI assigned
May 13, 2021
Last updated
May 14, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 14, 2021

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

Authorized official

Name
Diane Vincur
Title
Clinical Support Talent Specialist
Phone
(561) 815-2427

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Gerontology Nurse Practitioner 363LG0600X NU
Primary Care Nurse Practitioner 363LP2300X NU Primary
Family Medicine Physician 207Q00000X NU
Geriatric Medicine (Family Medicine) Physician 207QG0300X NU

Addresses

Primary practice location

4300 Rock Island Rd
Lauderhill, FL 33319-4528

Mailing address

11770 US 1
Palm Beach Gardens, FL 33408-3027
Phone (561) 815-2427

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210811003233 FL Part B Supplier - Clinic/Group Practice 2163826249 Receives reassigned benefits from 31 practitioners

National Provider Directory

National Provider Directory

Locations

4300 Rock Island Rd
Lauderhill, FL 33319
Phone (954) 309-1126

5405 Babcock St NE
Palm Bay, FL 32905
Phone (321) 722-0660

1000 24th St N
St Petersburg, FL 33713
Phone (727) 323-4711

521 Atwood Ave N
St Petersburg, FL 33702
Phone (727) 526-7000

Practitioners & affiliated clinicians

Practitioners 33

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 33

NPI Registry JSON

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

{
    "created_epoch": "1620864000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1620950400000",
    "number": "1639743750",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11770 US 1",
            "city": "PALM BEACH GARDENS",
            "state": "FL",
            "postal_code": "334083027",
            "telephone_number": "561-815-2427"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4300 ROCK ISLAND RD",
            "city": "LAUDERHILL",
            "state": "FL",
            "postal_code": "333194528",
            "telephone_number": "954-485-6144"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LONGEVITY CLINICAL LTC ASSOCIATES OF FLORIDA PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-13",
        "last_updated": "2021-05-14",
        "certification_date": "2021-05-14",
        "status": "A",
        "authorized_official_last_name": "VINCUR",
        "authorized_official_first_name": "DIANE",
        "authorized_official_title_or_position": "CLINICAL SUPPORT TALENT SPECIALIST",
        "authorized_official_telephone_number": "561-815-2427"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207QG0300X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lauderhill, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.