Healthcare Provider Details

I. General information

NPI: 1275358855
Provider Name (Legal Business Name): ST TIMOTHY URGENT CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2024
Last Update Date: 10/16/2025
Certification Date: 10/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16244 REDSTONE WAY
ODESSA FL
33556-4668
US

IV. Provider business mailing address

16244 REDSTONE WAY
ODESSA FL
33556-4668
US

V. Phone/Fax

Practice location:
  • Phone: 352-835-7111
  • Fax: 727-223-4159
Mailing address:
  • Phone: 813-430-0900
  • Fax: 813-430-0800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: EID GUIRGUIS
Title or Position: OWNER
Credential: MD
Phone: 352-835-7111