Healthcare Provider Details

I. General information

NPI: 1013157668
Provider Name (Legal Business Name): FLORIDA TRUST NETWORK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2009
Last Update Date: 02/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5201 BLUE LAGOON DR SUITE 270
MIAMI FL
33126-2064
US

IV. Provider business mailing address

5201 BLUE LAGOON DR SUITE 270
MIAMI FL
33126-2064
US

V. Phone/Fax

Practice location:
  • Phone: 305-262-7292
  • Fax: 786-513-0748
Mailing address:
  • Phone: 305-262-7292
  • Fax: 786-513-0748

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. JEFFREY TODD KING
Title or Position: EXECUTIVE DIRECTOR
Credential: RN, MBA, CDE
Phone: 305-262-1292