Healthcare Provider Details

I. General information

NPI: 1770411571
Provider Name (Legal Business Name): SUNSHINE STATE SENIOR CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 ULMERTON RD STE 625-35
CLEARWATER FL
33762-2300
US

IV. Provider business mailing address

1901 ULMERTON RD STE 625-35
CLEARWATER FL
33762-2300
US

V. Phone/Fax

Practice location:
  • Phone: 727-495-4228
  • Fax:
Mailing address:
  • Phone: 727-495-4228
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: ROBERT KOEHLER
Title or Position: OWNER
Credential:
Phone: 727-495-4228