Healthcare Provider Details

I. General information

NPI: 1457166571
Provider Name (Legal Business Name): CARDIOVASCULAR INSTITUTE OF CENTRAL FLORIDA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2025
Last Update Date: 08/06/2025
Certification Date: 08/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6511 SW HIGHWAY 200
OCALA FL
34476
US

IV. Provider business mailing address

2111 SW 20TH PL
OCALA FL
34471-7734
US

V. Phone/Fax

Practice location:
  • Phone: 352-622-4251
  • Fax: 352-622-0102
Mailing address:
  • Phone: 352-622-4251
  • Fax: 352-622-0102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC3500X
TaxonomyCardiac Rehabilitation Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code2471C1106X
TaxonomyCardiac-Interventional Technology Radiologic Technologist
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code261QR0404X
TaxonomyCardiac Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RANDY WARDLOW
Title or Position: CEO
Credential:
Phone: 352-622-4251