Healthcare Provider Details

I. General information

NPI: 1124551429
Provider Name (Legal Business Name): PRIME HEALTH PARTNERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2017
Last Update Date: 04/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14100 US HIGHWAY 19 N SUITE 132
CLEARWATER FL
33764-7241
US

IV. Provider business mailing address

1694 BAYHILL DR
OLDSMAR FL
34677-1956
US

V. Phone/Fax

Practice location:
  • Phone: 727-439-2677
  • Fax: 727-431-6870
Mailing address:
  • Phone: 727-439-2677
  • Fax: 727-431-6870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberOS6109
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MR. ZEFF RAFAEL BONA
Title or Position: OWNER
Credential:
Phone: 727-787-1260