Healthcare Provider Details

I. General information

NPI: 1063459238
Provider Name (Legal Business Name): PHYSICIAN'S WALK IN CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24420 STATE ROAD 54
LUTZ FL
33559-7303
US

IV. Provider business mailing address

24420 STATE ROAD 54
LUTZ FL
33559-7303
US

V. Phone/Fax

Practice location:
  • Phone: 813-948-2453
  • Fax:
Mailing address:
  • Phone: 813-948-2453
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: CHRISTINA HOWELL
Title or Position: ASSISTANT ADMINISTRATOR
Credential:
Phone: 813-948-2453