Healthcare Provider Details

I. General information

NPI: 1497425425
Provider Name (Legal Business Name): ENCORE INFUSION FLORIDA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2021
Last Update Date: 02/24/2023
Certification Date: 02/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3555 KRAFT RD UNIT 200
NAPLES FL
34105-5043
US

IV. Provider business mailing address

PO BOX 32789
PALM BEACH GARDENS FL
33420-2789
US

V. Phone/Fax

Practice location:
  • Phone: 865-862-4557
  • Fax: 865-862-4556
Mailing address:
  • Phone: 561-327-4970
  • Fax: 561-823-0829

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: STACEY SHELTON
Title or Position: DIRECTOR OF BUSINESS DEVELOPMENT
Credential:
Phone: 513-313-9014