Healthcare Provider Details

I. General information

NPI: 1811484751
Provider Name (Legal Business Name): DOCTORS INN ONE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2018
Last Update Date: 07/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1811 SHORE DR S
S PASADENA FL
33707
US

IV. Provider business mailing address

2410 NORTHSIDE DR
CLEARWATER FL
33761-2236
US

V. Phone/Fax

Practice location:
  • Phone: 727-391-4100
  • Fax: 727-398-2067
Mailing address:
  • Phone: 727-499-0356
  • Fax: 727-781-3312

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS
License Number StateFL

VIII. Authorized Official

Name: EHREN CARINE
Title or Position: PRESIDENT
Credential: DO
Phone: 727-391-4100