Healthcare Provider Details

I. General information

NPI: 1205549029
Provider Name (Legal Business Name): P3 HEALTH PARTNERS-FLORIDA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2022
Last Update Date: 12/27/2022
Certification Date: 12/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13501 ICOT BLVD STE 114
CLEARWATER FL
33760-3729
US

IV. Provider business mailing address

2370 CORPORATE CIR STE 300
HENDERSON NV
89074-7760
US

V. Phone/Fax

Practice location:
  • Phone: 727-754-7880
  • Fax: 727-754-7885
Mailing address:
  • Phone: 702-910-3950
  • Fax: 702-786-6650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BEVERLY DENDARY
Title or Position: CREDENTIALING SUPERVISOR
Credential:
Phone: 702-910-3950