Healthcare Provider Details

I. General information

NPI: 1538245709
Provider Name (Legal Business Name): FAMILY PRACTICE AND INJURY CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 01/11/2020
Certification Date: 01/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4701 CENTRAL AVE STE A
SAINT PETERSBURG FL
33713-8153
US

IV. Provider business mailing address

4701 CENTRAL AVE STE A
SAINT PETERSBURG FL
33713-8153
US

V. Phone/Fax

Practice location:
  • Phone: 727-347-3213
  • Fax: 727-345-6923
Mailing address:
  • Phone: 727-347-3213
  • Fax: 727-345-6923

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberFLOS00004912
License Number StateFL

VIII. Authorized Official

Name: NILA J ALLEN
Title or Position: OFFICE MANAGER
Credential:
Phone: 727-347-3213