Daegavinchris,LLC

Primary specialty

Gerontology Nurse PractitionerTaxonomy code 363LG0600X

Legal business name

DAEGAVINCHRIS,LLC

Practice address

4574 SW Tabor St
Port St Lucie, FL 34953-6740

Phone

(772) 626-1002

Fax

(772) 871-0055

NPI assigned

Oct 14, 2019

Organization subpart

No

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

Authorized official

Name

Claudine George, ARNP

Title

Owner

Phone

(772) 626-1002

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1571011200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1588896000000",
    "number": "1891337655",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4574 SW TABOR ST",
            "city": "PORT ST LUCIE",
            "state": "FL",
            "postal_code": "349536740",
            "telephone_number": "772-626-1002",
            "fax_number": "772-871-0055"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4574 SW TABOR ST",
            "city": "PORT ST LUCIE",
            "state": "FL",
            "postal_code": "349536740",
            "telephone_number": "772-626-1002",
            "fax_number": "772-871-0055"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DAEGAVINCHRIS,LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-10-14",
        "last_updated": "2020-05-08",
        "certification_date": "2020-05-08",
        "status": "A",
        "authorized_official_last_name": "GEORGE",
        "authorized_official_first_name": "CLAUDINE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "772-626-1002",
        "authorized_official_credential": "ARNP"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Gerontology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Gerontology Nurse Practitioner in Port St Lucie, FL
• Providers in Port St Lucie, FL by specialty
• Gerontology Nurse Practitioner in Florida

• 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.