Provider Demographics
NPI:1023872827
Name:LIGHTHOUSE PRIMARY CARE, LLC
Entity type:Organization
Organization Name:LIGHTHOUSE PRIMARY CARE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DNP, APRN, FNP-C
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:EGGLESTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-674-4545
Mailing Address - Street 1:PO BOX 515
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19903-0515
Mailing Address - Country:US
Mailing Address - Phone:302-674-4545
Mailing Address - Fax:800-507-3166
Practice Address - Street 1:1288 S GOVERNORS AVE STE B
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-4802
Practice Address - Country:US
Practice Address - Phone:302-674-4545
Practice Address - Fax:800-507-3166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-12
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty