Healthcare Provider Details

I. General information

NPI: 1578335535
Provider Name (Legal Business Name): ACCESS BRANDON-RIVERVIEW LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2023
Last Update Date: 10/24/2023
Certification Date: 10/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13111 US HIGHWAY 301 S
RIVERVIEW FL
33578-7401
US

IV. Provider business mailing address

14690 SPRING HILL DR STE 100
SPRING HILL FL
34609-8102
US

V. Phone/Fax

Practice location:
  • Phone: 813-671-0064
  • Fax: 813-672-2153
Mailing address:
  • Phone: 352-799-0046
  • Fax: 352-799-0042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: KAREN P HAYES
Title or Position: CFO
Credential:
Phone: 352-799-0046