Healthcare Provider Details

I. General information

NPI: 1043252307
Provider Name (Legal Business Name): FLORIDA FACILITISTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 W LAKE BRANTLEY RD
LONGWOOD FL
32779-4766
US

IV. Provider business mailing address

2000 PREVATT ST SUITE B3
EUSTIS FL
32726-6149
US

V. Phone/Fax

Practice location:
  • Phone: 321-273-0301
  • Fax:
Mailing address:
  • Phone: 321-273-0301
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MR. JOHN HANSON RAUCH
Title or Position: MANAGER
Credential:
Phone: 321-273-0301