Healthcare Provider Details

I. General information

NPI: 1124450077
Provider Name (Legal Business Name): HISPANIC HEALTH ENTERPRISES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2013
Last Update Date: 11/25/2025
Certification Date: 11/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4990 GOLDEN GATE PKWY
NAPLES FL
34116-6962
US

IV. Provider business mailing address

4990 GOLDEN GATE PKWY
NAPLES FL
34116-6962
US

V. Phone/Fax

Practice location:
  • Phone: 239-692-8309
  • Fax: 239-692-8504
Mailing address:
  • Phone: 239-692-8309
  • Fax: 239-692-8504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: TABARE D TABAR
Title or Position: PRESIDENT
Credential: P.A.
Phone: 239-331-9610