Healthcare Provider Details

I. General information

NPI: 1902753130
Provider Name (Legal Business Name): FLORIDA CARE MEDICAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2026
Last Update Date: 03/16/2026
Certification Date: 03/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4691 OLD CANOE CREEK RD
SAINT CLOUD FL
34769-1550
US

IV. Provider business mailing address

7200 CURRY FORD RD
ORLANDO FL
32822-5806
US

V. Phone/Fax

Practice location:
  • Phone: 407-842-8283
  • Fax: 407-603-8285
Mailing address:
  • Phone: 407-842-8283
  • Fax: 407-603-8285

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: PEDRO ENRIQUE LASTRES HERNANDEZ
Title or Position: OWNER
Credential:
Phone: 407-842-8283