Healthcare Provider Details

I. General information

NPI: 1649259144
Provider Name (Legal Business Name): ADVANCE FAMILY PRACTICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2006
Last Update Date: 02/07/2025
Certification Date: 02/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1910 N ORANGE AVE
ORLANDO FL
32804-5528
US

IV. Provider business mailing address

1910 N ORANGE AVE
ORLANDO FL
32804
US

V. Phone/Fax

Practice location:
  • Phone: 407-898-1451
  • Fax: 407-897-8626
Mailing address:
  • Phone: 407-898-1451
  • Fax: 407-897-8626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: VARESH R PATEL
Title or Position: PRESIDENT
Credential: DO
Phone: 407-898-1451