Healthcare Provider Details

I. General information

NPI: 1972806628
Provider Name (Legal Business Name): ADVANTACARE OF FLORIDA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2010
Last Update Date: 12/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 WEST OAK STREET
KISSIMMEE FL
34741
US

IV. Provider business mailing address

40 ALEXANDRIA BOULEVARD SUITE 1020
OVIEDO FL
32765
US

V. Phone/Fax

Practice location:
  • Phone: 407-350-4951
  • Fax: 407-350-4953
Mailing address:
  • Phone: 407-359-0047
  • Fax: 407-359-3207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH 9595
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: KERRI HERZOG
Title or Position: OFFICE MANAGER
Credential:
Phone: 407-359-0047