Provider Demographics
NPI:1386026342
Name:PHYSICIAN PARTNERS OF AMERICA FLORIDA MEDICAL HOLDINGS LLC
Entity type:Organization
Organization Name:PHYSICIAN PARTNERS OF AMERICA FLORIDA MEDICAL HOLDINGS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-549-2134
Mailing Address - Street 1:4730 N HABANA AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-7163
Mailing Address - Country:US
Mailing Address - Phone:813-549-2134
Mailing Address - Fax:813-870-1383
Practice Address - Street 1:4726 N HABANA AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-7144
Practice Address - Country:US
Practice Address - Phone:813-549-2134
Practice Address - Fax:813-870-1383
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PHYSICIAN PARTNERS OF AMERICA FLORIDA MEDICAL HOLDINGS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-06-25
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty