Healthcare Provider Details

I. General information

NPI: 1972942472
Provider Name (Legal Business Name): FLORIDA CLINICAL PRACTICE ASSOCIATION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2013
Last Update Date: 10/29/2020
Certification Date: 10/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6201 W NEWBERRY RD
GAINESVILLE FL
32605-4305
US

IV. Provider business mailing address

PO BOX 13833
PHILADELPHIA PA
19101-3833
US

V. Phone/Fax

Practice location:
  • Phone: 352-265-2020
  • Fax:
Mailing address:
  • Phone: 352-265-7080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: JEREMY SIBISKI
Title or Position: EXECUTIVE VICE PRESIDENT
Credential:
Phone: 352-265-8017