Healthcare Provider Details

I. General information

NPI: 1902977416
Provider Name (Legal Business Name): FLORIDA INFUSION SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4190 CORPORATE COURT
PALM HARBOR FL
34683-1412
US

IV. Provider business mailing address

4190 CORPORATE COURT
PALM HARBOR FL
34683-1412
US

V. Phone/Fax

Practice location:
  • Phone: 727-943-9900
  • Fax: 727-943-0852
Mailing address:
  • Phone: 727-943-9900
  • Fax: 727-943-0852

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License NumberPH9911
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPH 9911
License Number StateFL

VIII. Authorized Official

Name: MR. RODOLFO CICCARELLO
Title or Position: PRESIDENT
Credential: R.PH.
Phone: 727-943-9900