Healthcare Provider Details

I. General information

NPI: 1265386536
Provider Name (Legal Business Name): PALM MEDICAL CENTER LAKELAND LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2026
Last Update Date: 02/24/2026
Certification Date: 02/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2250 OSPREY BLVD STE 101
BARTOW FL
33830-4340
US

IV. Provider business mailing address

2600 S DOUGLAS RD STE 308
CORAL GABLES FL
33134-6134
US

V. Phone/Fax

Practice location:
  • Phone: 863-533-8215
  • Fax: 863-533-8221
Mailing address:
  • Phone: 305-913-9454
  • Fax: 305-442-1198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: CARMEL N BOSWELL
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 813-538-7880