Healthcare Provider Details

I. General information

NPI: 1568002459
Provider Name (Legal Business Name): SOUTH FLORIDA INJURY AND CONVENIENT CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2020
Last Update Date: 05/11/2022
Certification Date: 05/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 MANATEE AVE W STE E
BRADENTON FL
34205-4942
US

IV. Provider business mailing address

2601 MANATEE AVE W STE E
BRADENTON FL
34205-4942
US

V. Phone/Fax

Practice location:
  • Phone: 941-744-0040
  • Fax:
Mailing address:
  • Phone: 941-744-0040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: KARLA N SALGADO
Title or Position: OFFICE MANAGER
Credential:
Phone: 941-744-0040