Healthcare Provider Details

I. General information

NPI: 1548205883
Provider Name (Legal Business Name): SOUTH FLORIDA BAPTIST HOSPITAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 08/01/2024
Certification Date: 08/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3202 N PARK RD
PLANT CITY FL
33563-2026
US

IV. Provider business mailing address

2995 DREW ST FL 2
CLEARWATER FL
33759-3012
US

V. Phone/Fax

Practice location:
  • Phone: 813-757-1200
  • Fax: 813-757-8204
Mailing address:
  • Phone: 727-281-9390
  • Fax: 813-635-2613

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number4056
License Number StateFL

VIII. Authorized Official

Name: MRS. LYNDA GORKEN
Title or Position: VICE PRESIDENT, PFS DIVISION
Credential:
Phone: 727-281-9065