Healthcare Provider Details

I. General information

NPI: 1528456548
Provider Name (Legal Business Name): FLORIDA PRACTITIONERS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2014
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

703 N FLAMINGO RD
PEMBROKE PINES FL
33028-1006
US

IV. Provider business mailing address

3310 WEST END AVE STE 620
NASHVILLE TN
37203-6910
US

V. Phone/Fax

Practice location:
  • Phone: 615-657-4800
  • Fax:
Mailing address:
  • Phone: 615-657-4800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA3649
License Number StateFL

VIII. Authorized Official

Name: JOHN TOBIAS GRAY
Title or Position: CEO
Credential: PA-C
Phone: 615-657-4800