Healthcare Provider Details

I. General information

NPI: 1134467376
Provider Name (Legal Business Name): ADVANTACARE OF FLORIDA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2013
Last Update Date: 09/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1040 MASON AVE
DAYTONA BEACH FL
32117-4612
US

IV. Provider business mailing address

697 MAITLAND AVE SUITE 1001
ALTAMONTE SPRINGS FL
32701-6821
US

V. Phone/Fax

Practice location:
  • Phone: 386-248-0107
  • Fax: 386-248-0109
Mailing address:
  • Phone: 407-539-2111
  • Fax: 407-539-1211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberME98460
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2081N0008X
TaxonomyNeuromuscular Medicine (Physical Medicine & Rehabilitation) Physician
License NumberME86688
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberME31437
License Number StateFL

VIII. Authorized Official

Name: DR. FRANK ALVAREZ
Title or Position: MANAGING MEMBER
Credential: M.D.
Phone: 386-248-0107