Healthcare Provider Details

I. General information

NPI: 1417866849
Provider Name (Legal Business Name): PERFORMANCE INNOVATIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11862 SW 32ND LN
GAINESVILLE FL
32608-8810
US

IV. Provider business mailing address

11862 SW 32ND LN
GAINESVILLE FL
32608-8810
US

V. Phone/Fax

Practice location:
  • Phone: 352-870-9079
  • Fax:
Mailing address:
  • Phone: 352-870-9079
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SHARAREH SHARIFIFAR
Title or Position: MANAGER
Credential: PT, PHD
Phone: 352-870-9079