Ertha Healthcare LLC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

Legal business name

ERTHA HEALTHCARE LLC

Practice address

674 Cecelia Ave SE
Palm Bay, FL 32909-4401

Phone

(321) 261-1058

NPI assigned

Dec 7, 2023

Last updated

Jan 29, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Marie Petiote, APRNNPI 1245930981

Title

Ceo

Phone

(321) 261-1058

Specialties & licenses 2

Addresses

Practitioners 1

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.

• Marie Petiote, APRN

  • Family Nurse Practitioner
  • Palm Bay, FL
  • NPI 1245930981
  Authorized official Same address or phone

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

{
    "created_epoch": "1701907200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1706486400000",
    "number": "1790552875",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "674 CECELIA AVE SE",
            "city": "PALM BAY",
            "state": "FL",
            "postal_code": "329094401",
            "telephone_number": "321-261-1058"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "674 CECELIA AVE SE",
            "city": "PALM BAY",
            "state": "FL",
            "postal_code": "329094401",
            "telephone_number": "321-261-1058"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ERTHA HEALTHCARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-12-07",
        "last_updated": "2024-01-29",
        "certification_date": "2024-01-18",
        "status": "A",
        "authorized_official_last_name": "PETIOTE",
        "authorized_official_first_name": "MARIE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "321-261-1058",
        "authorized_official_credential": "APRN"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Family Nurse Practitioner in Palm Bay, FL
• Providers in Palm Bay, FL by specialty
• Family Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2024; 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.