Healthcare Provider Details

I. General information

NPI: 1740572825
Provider Name (Legal Business Name): CARE ONE PRIMARY CARE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2011
Last Update Date: 11/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12224 CORTEZ BLVD
BROOKSVILLE FL
34613-2631
US

IV. Provider business mailing address

12224 CORTEZ BLVD
BROOKSVILLE FL
34613-2631
US

V. Phone/Fax

Practice location:
  • Phone: 352-610-9905
  • Fax: 352-610-9907
Mailing address:
  • Phone: 352-610-9905
  • Fax: 352-610-9907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. ANTHONY PETER LAVIANO
Title or Position: MANAGING PARTNER
Credential: ARNP
Phone: 352-610-9905