Healthcare Provider Details

I. General information

NPI: 1245903301
Provider Name (Legal Business Name): HEART OF FLORIDA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2021
Last Update Date: 02/07/2023
Certification Date: 02/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6041 SW 54TH ST STE 100
OCALA FL
34474-5521
US

IV. Provider business mailing address

1025 SW 1ST AVE
OCALA FL
34471-0900
US

V. Phone/Fax

Practice location:
  • Phone: 352-732-6599
  • Fax:
Mailing address:
  • Phone: 352-732-6599
  • 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: MATTHEW CLAY
Title or Position: CEO
Credential:
Phone: 352-732-6599