Organization · Type 2 NPI

Florida Atlantic University

Gerontology Nurse Practitioner · Boca Raton, FL

NPI number 1164591954 Active

Practice location

777 Glades Rd, Bldg AZ-79
Boca Raton, FL 33431-6424

Call (561) 297-0502 Map

Fax (561) 297-0505

Mailing address

777 Glades Rd Bldg AZ-79
Boca Raton, FL 33431-6424

Specialties and licenses

Taxonomy	Code	License
Clinical Neuropsychologist	103G00000X	None listed
Clinical Psychologist	103TC0700X	None listed
Gerontology Nurse Practitioner Primary	363LG0600X	None listed

Gerontology Nurse Practitioner: Definition to come...

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NPI record

NPI: 1164591954
Entity type: Organization (Type 2)
Issued: Nov 7, 2006
Last updated: Dec 15, 2025
Status: Active
Subpart: Yes of Florida Atlantic University

Other names

<unavail>
Memory and Wellness Center · doing business as
Memory and Wellness Center · doing business as

Authorized official

Louisa Pontiroli-Kelly
Authorized Official
(561) 297-2897

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This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1164591954

Florida Atlantic University's National Provider Identifier is 1164591954, issued on Nov 7, 2006. The primary taxonomy on file is Gerontology Nurse Practitioner (363LG0600X), and the practice location is in Boca Raton, FL. The record was last updated on Dec 15, 2025.