Healthcare Provider Details

I. General information

NPI: 1114509072
Provider Name (Legal Business Name): PEDIATRIC HEALTH CHOICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2021
Last Update Date: 03/28/2022
Certification Date: 03/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2102 SW 20TH PL BLDG 500
OCALA FL
34471-0861
US

IV. Provider business mailing address

8509 BENJAMIN RD STE D
TAMPA FL
33634-1224
US

V. Phone/Fax

Practice location:
  • Phone: 352-873-7247
  • Fax:
Mailing address:
  • Phone: 813-769-5358
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: HEIDI TOSTI
Title or Position: VP FINANCE
Credential:
Phone: 813-880-0320