Provider Demographics
NPI:1386313674
Name:HEART 2 HEART FAMILY PRACTICE
Entity type:Organization
Organization Name:HEART 2 HEART FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DOLLICIA
Authorized Official - Middle Name:MICHELE
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-659-2104
Mailing Address - Street 1:1326 STATE ROAD 100
Mailing Address - Street 2:
Mailing Address - City:MELROSE
Mailing Address - State:FL
Mailing Address - Zip Code:32666-3701
Mailing Address - Country:US
Mailing Address - Phone:386-659-2104
Mailing Address - Fax:386-659-2196
Practice Address - Street 1:1326 STATE ROAD 100
Practice Address - Street 2:
Practice Address - City:MELROSE
Practice Address - State:FL
Practice Address - Zip Code:32666-3701
Practice Address - Country:US
Practice Address - Phone:386-659-2104
Practice Address - Fax:386-659-2196
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-09
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty