Healthcare Provider Details

I. General information

NPI: 1356883672
Provider Name (Legal Business Name): FIFTH CIRCUIT PULIC GUARDIAN CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2016
Last Update Date: 11/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 NW 1ST ST COURTHOUSE
OCALA FL
34475
US

IV. Provider business mailing address

P.O. BOX 4985
OCALA FL
34478
US

V. Phone/Fax

Practice location:
  • Phone: 352-401-6753
  • Fax: 352-401-7803
Mailing address:
  • Phone: 352-401-6753
  • Fax: 352-401-7803

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: CATHERINE F ACKERMAN
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 352-401-6753