Healthcare Provider Details

I. General information

NPI: 1235545344
Provider Name (Legal Business Name): AFTER CARE CENTER OF FLORIDA AT HOLIDAY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2014
Last Update Date: 07/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1812 US HIGHWAY 19
HOLIDAY FL
34691-5535
US

IV. Provider business mailing address

1812 US HIGHWAY 19
HOLIDAY FL
34691-5535
US

V. Phone/Fax

Practice location:
  • Phone: 727-943-0300
  • Fax: 727-943-0339
Mailing address:
  • Phone: 727-943-0300
  • Fax: 727-943-0339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH7280
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA9101542
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberARNP9196368
License Number StateFL

VIII. Authorized Official

Name: MISS DONNA BORGIA
Title or Position: ADMINISTRATOR
Credential:
Phone: 727-943-0300