Healthcare Provider Details

I. General information

NPI: 1003575390
Provider Name (Legal Business Name): SYNERGIC HEALTHCARE SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2021
Last Update Date: 12/09/2024
Certification Date: 12/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6182 N US HIGHWAY 41
APOLLO BEACH FL
33572
US

IV. Provider business mailing address

3301 W GANDY BLVD
TAMPA FL
33611-2931
US

V. Phone/Fax

Practice location:
  • Phone: 813-925-1903
  • Fax: 813-749-8369
Mailing address:
  • Phone: 813-925-1903
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DARON G. DIECIDUE
Title or Position: MEMBER MANAGER
Credential: MD
Phone: 813-925-1903