Provider Demographics
NPI:1588675912
Name:MID FLORIDA HOSPITAL SPECIALISTS PA
Entity type:Organization
Organization Name:MID FLORIDA HOSPITAL SPECIALISTS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TANYA
Authorized Official - Middle Name:
Authorized Official - Last Name:AGARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-207-0172
Mailing Address - Street 1:5703 RED BUG LAKE ROAD
Mailing Address - Street 2:#341
Mailing Address - City:WINTER SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32708-4969
Mailing Address - Country:US
Mailing Address - Phone:407-849-7500
Mailing Address - Fax:321-207-0175
Practice Address - Street 1:5717 RED BUG LAKE RD # 341
Practice Address - Street 2:
Practice Address - City:WINTER SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32708-4957
Practice Address - Country:US
Practice Address - Phone:407-321-0172
Practice Address - Fax:321-207-0175
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty