Provider Demographics
NPI:1366207250
Name:TIME IN RANGE, LLC
Entity type:Organization
Organization Name:TIME IN RANGE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:LAURI
Authorized Official - Middle Name:
Authorized Official - Last Name:DEANE
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, CDCES
Authorized Official - Phone:954-536-5353
Mailing Address - Street 1:3321 PORT ROYALE DR S APT 410
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-7948
Mailing Address - Country:US
Mailing Address - Phone:954-536-5353
Mailing Address - Fax:
Practice Address - Street 1:433 PLAZA REAL STE 275
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33432-3999
Practice Address - Country:US
Practice Address - Phone:954-289-2455
Practice Address - Fax:949-695-4633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-19
Last Update Date:2024-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty