Healthcare Provider Details

I. General information

NPI: 1083989438
Provider Name (Legal Business Name): PRIMARY CARE PROVIDERS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2012
Last Update Date: 11/11/2020
Certification Date: 11/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

635 SE 17TH ST
OCALA FL
34471-4428
US

IV. Provider business mailing address

1202 SW 17TH ST SUITE 201 BOX 168
OCALA FL
34471-1283
US

V. Phone/Fax

Practice location:
  • Phone: 352-237-4877
  • Fax: 352-237-4880
Mailing address:
  • Phone: 352-237-4877
  • Fax: 352-237-4880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARNP663102
License Number StateFL

VIII. Authorized Official

Name: LINDA LEE STRUVE-DOERFLEIN
Title or Position: PRESIDENT
Credential: ARNP
Phone: 352-816-1800