Healthcare Provider Details

I. General information

NPI: 1114497005
Provider Name (Legal Business Name): EMERGENT PHYSICIANS OF COUNTRY WALK, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2018
Last Update Date: 08/19/2025
Certification Date: 08/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14150 SW 136TH ST
MIAMI FL
33186-5506
US

IV. Provider business mailing address

PO BOX 161624
ALTAMONTE SPRINGS FL
32716-1624
US

V. Phone/Fax

Practice location:
  • Phone: 786-204-4600
  • Fax:
Mailing address:
  • Phone: 786-888-8820
  • Fax: 786-591-6025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PP0204X
TaxonomyPediatric Emergency Medicine (Emergency Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: GABRIELA PICADO
Title or Position: OFFICE MANAGER
Credential:
Phone: 786-888-8820