Healthcare Provider Details

I. General information

NPI: 1164014957
Provider Name (Legal Business Name): FLORIDA CLINICAL PRACTICE ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2021
Last Update Date: 07/26/2021
Certification Date: 07/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 MEDICAL PLAZA DR
LEESBURG FL
34748-7313
US

IV. Provider business mailing address

PO BOX 13833
PHILADELPHIA PA
19101-3833
US

V. Phone/Fax

Practice location:
  • Phone: 352-273-7001
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. JEREMY SIBISKI
Title or Position: EXECUTIVE VICE PRESIDENT
Credential:
Phone: 352-265-8017