Provider Demographics
NPI:1730706078
Name:MOBILE PRACTITIONER SERVICES INC.
Entity type:Organization
Organization Name:MOBILE PRACTITIONER SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PMHNP/FNP
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:ENGRAM
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:561-662-2198
Mailing Address - Street 1:1565 W 36TH ST
Mailing Address - Street 2:
Mailing Address - City:RIVIERA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33404-2009
Mailing Address - Country:US
Mailing Address - Phone:561-662-2198
Mailing Address - Fax:561-828-3884
Practice Address - Street 1:1565 W 36TH ST
Practice Address - Street 2:
Practice Address - City:RIVIERA BEACH
Practice Address - State:FL
Practice Address - Zip Code:33404-2009
Practice Address - Country:US
Practice Address - Phone:561-662-2198
Practice Address - Fax:561-828-9884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-02
Last Update Date:2020-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty