Healthcare Provider Details

I. General information

NPI: 1376204370
Provider Name (Legal Business Name): FLORIDA ENT ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2022
Last Update Date: 01/06/2023
Certification Date: 01/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 NE 30TH TER STE 214
HOMESTEAD FL
33033-7614
US

IV. Provider business mailing address

15280 NW 79TH CT STE 200
MIAMI LAKES FL
33016-5873
US

V. Phone/Fax

Practice location:
  • Phone: 305-245-5881
  • Fax: 305-245-2723
Mailing address:
  • Phone: 305-558-3724
  • Fax: 786-907-4485

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State

VIII. Authorized Official

Name: ASHLEY HODGKISS
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 305-558-3724