Healthcare Provider Details

I. General information

NPI: 1750097176
Provider Name (Legal Business Name): GENTLE FOOT CARE CLINIC, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2023
Last Update Date: 01/30/2023
Certification Date: 01/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 LITHIA PINECREST RD
BRANDON FL
33511-6114
US

IV. Provider business mailing address

601 LITHIA PINECREST RD
BRANDON FL
33511-6114
US

V. Phone/Fax

Practice location:
  • Phone: 813-782-3233
  • Fax: 813-502-5904
Mailing address:
  • Phone: 813-782-3233
  • Fax: 813-502-5904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: JAIRO B CRUZ
Title or Position: MEDICAL DIRECTOR
Credential: DPM
Phone: 813-782-3233