Provider Demographics
NPI:1427698661
Name:FLORIDA HEART & VASCULAR MULTI SPECIALTY GROUP PA
Entity type:Organization
Organization Name:FLORIDA HEART & VASCULAR MULTI SPECIALTY GROUP PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:JACKIE
Authorized Official - Middle Name:
Authorized Official - Last Name:FAUNDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-323-9501
Mailing Address - Street 1:511 MEDICAL PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-7326
Mailing Address - Country:US
Mailing Address - Phone:352-728-6808
Mailing Address - Fax:352-728-1743
Practice Address - Street 1:27637 US HIGHWAY 27
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-9033
Practice Address - Country:US
Practice Address - Phone:352-326-6001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FLORIDA HEART & VASCULAR MULTI SPECIALTY GROUP PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-01-15
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty