Healthcare Provider Details

I. General information

NPI: 1861028409
Provider Name (Legal Business Name): CHF CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2020
Last Update Date: 03/23/2020
Certification Date: 03/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4211 VAN DYKE RD
LUTZ FL
33558-8005
US

IV. Provider business mailing address

3853 NORTHDALE BLVD STE 367
TAMPA FL
33624-1861
US

V. Phone/Fax

Practice location:
  • Phone: 813-443-7000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0001X
TaxonomyAdvanced Heart Failure and Transplant Cardiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. AUGUSTINE E AGOCHA
Title or Position: CEO
Credential: MD
Phone: 813-220-2122