Healthcare Provider Details

I. General information

NPI: 1033152822
Provider Name (Legal Business Name): FLORIDA HEART AND VASCULAR SURGEONS, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 01/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1511 SW 1ST AVE
OCALA FL
34471-6505
US

IV. Provider business mailing address

PO BOX 3130
OCALA FL
34478-3130
US

V. Phone/Fax

Practice location:
  • Phone: 352-867-8311
  • Fax: 352-622-5771
Mailing address:
  • Phone: 352-867-8311
  • Fax: 352-622-5771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: TREVA D. WIDDIS
Title or Position: ASSOCIATE EXECUTIVE DIRECTOR
Credential:
Phone: 352-867-8311