Healthcare Provider Details

I. General information

NPI: 1568974798
Provider Name (Legal Business Name): FYZAMEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2017
Last Update Date: 12/18/2020
Certification Date: 12/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7209 CURRY FORD RD STE B
ORLANDO FL
32822-5809
US

IV. Provider business mailing address

142 BLACKSTONE CREEK RD
GROVELAND FL
34736-3621
US

V. Phone/Fax

Practice location:
  • Phone: 407-501-8563
  • Fax: 512-532-0923
Mailing address:
  • Phone: 407-668-5525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: TYLER PENROD
Title or Position: BILLER
Credential:
Phone: 305-907-4175