Healthcare Provider Details

I. General information

NPI: 1407637531
Provider Name (Legal Business Name): TAMPA GENERAL HOSPITAL CITRUS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2023
Last Update Date: 08/30/2024
Certification Date: 08/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6201 N SUNCOAST BLVD
CRYSTAL RIVER FL
34428-6712
US

IV. Provider business mailing address

PO BOX 1289
TAMPA FL
33601-1289
US

V. Phone/Fax

Practice location:
  • Phone: 352-795-6560
  • Fax: 352-795-8369
Mailing address:
  • Phone: 813-844-3956
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QE0002X
TaxonomyEmergency Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: MARK RUNYON
Title or Position: EVP CHIEF FINANCIAL OFCR FHSC
Credential:
Phone: 813-844-4805