Healthcare Provider Details

I. General information

NPI: 1457884397
Provider Name (Legal Business Name): AMBAREEN PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2017
Last Update Date: 04/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7109 NW 11TH PL
GAINESVILLE FL
32605-3170
US

IV. Provider business mailing address

7109 NW 11TH PL
GAINESVILLE FL
32605-3170
US

V. Phone/Fax

Practice location:
  • Phone: 352-331-2890
  • Fax: 352-331-2915
Mailing address:
  • Phone: 352-331-2890
  • Fax: 352-331-2915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME 97329
License Number StateFL

VIII. Authorized Official

Name: DR. FARRUKH AMBAREEN
Title or Position: PRESIDENT
Credential: MD
Phone: 352-331-2890