Healthcare Provider Details

I. General information

NPI: 1174852412
Provider Name (Legal Business Name): ADVANTACARE OF FLORIDA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2009
Last Update Date: 01/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2808 ENTERPRISE RD SUITE 105
DEBARY FL
32713-2753
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 386-668-2525
  • Fax: 386-668-2585
Mailing address:
  • Phone: 407-539-2111
  • Fax: 407-539-1211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: FRANK S ALVAREZ JR.
Title or Position: MANAGING MEMBER
Credential: MD
Phone: 407-539-2111