Healthcare Provider Details

I. General information

NPI: 1346678901
Provider Name (Legal Business Name): SNF PROFESSIONAL PHYSICIANS OF FLORIDA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2013
Last Update Date: 10/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 CELEBRATION BLVD
CELEBRATION FL
34747-5009
US

IV. Provider business mailing address

117 CELEBRATION BLVD
CELEBRATION FL
34747-5009
US

V. Phone/Fax

Practice location:
  • Phone: 407-900-0390
  • Fax:
Mailing address:
  • Phone: 407-900-0390
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: PAMELA R GLOVER
Title or Position: OWNER
Credential:
Phone: 863-412-5962