Healthcare Provider Details

I. General information

NPI: 1215670898
Provider Name (Legal Business Name): FLORIDA HOSPITAL PHYSICIAN GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2022
Last Update Date: 04/20/2022
Certification Date: 04/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 S 11TH ST
LAKE WALES FL
33853-4239
US

IV. Provider business mailing address

900 HOPE WAY ADVENTHEALTH MANAGED CARE
ALTAMONTE SPRINGS FL
32714-1502
US

V. Phone/Fax

Practice location:
  • Phone: 863-679-2707
  • Fax: 863-676-3621
Mailing address:
  • Phone: 407-357-1874
  • Fax: 407-357-1679

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State

VIII. Authorized Official

Name: JAMES C PRESSWOOD
Title or Position: CFO
Credential:
Phone: 386-615-4237