Healthcare Provider Details

I. General information

NPI: 1114514809
Provider Name (Legal Business Name): FAMILY CARE MEDICAL CENTER II LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2020
Last Update Date: 07/21/2021
Certification Date: 07/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

819 N MILLS AVE
ARCADIA FL
34266-8716
US

IV. Provider business mailing address

819 N MILLS AVE
ARCADIA FL
34266-8716
US

V. Phone/Fax

Practice location:
  • Phone: 863-491-2277
  • Fax: 863-491-3077
Mailing address:
  • Phone: 863-491-2277
  • Fax: 863-491-3077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: KENAN M CETIN
Title or Position: OWNER
Credential: PA-C
Phone: 863-491-2277