Healthcare Provider Details

I. General information

NPI: 1962510552
Provider Name (Legal Business Name): YOUR CARE CLINICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 01/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10225 ULMERTON RD STE 9A
LARGO FL
33771
US

IV. Provider business mailing address

10225 ULMERTON RD STE 9A
LARGO FL
33771-3526
US

V. Phone/Fax

Practice location:
  • Phone: 727-588-7600
  • Fax: 727-303-3348
Mailing address:
  • Phone: 727-588-7665
  • Fax: 727-230-9194

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: PHYLLIS FRIEDRICH
Title or Position: COO
Credential:
Phone: 727-588-7665