Healthcare Provider Details

I. General information

NPI: 1477201622
Provider Name (Legal Business Name): FLORIDA CLINICAL PRACTICE ASSOCIATION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2022
Last Update Date: 03/23/2022
Certification Date: 03/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4197 NW 86TH TER FL 3
GAINESVILLE FL
32606-9278
US

IV. Provider business mailing address

PO BOX 13833
PHILADELPHIA PA
19101-3833
US

V. Phone/Fax

Practice location:
  • Phone: 352-265-4357
  • Fax: 352-627-4161
Mailing address:
  • Phone: 352-265-7922
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MARVIN A. DEWAR
Title or Position: CEO
Credential: MD
Phone: 352-265-8309