Healthcare Provider Details

I. General information

NPI: 1154075026
Provider Name (Legal Business Name): HIGHLANDS COMPREHENSIVE CRITICAL CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2022
Last Update Date: 11/10/2022
Certification Date: 11/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4145 SUN N LAKE BLVD STE A
SEBRING FL
33872-2131
US

IV. Provider business mailing address

4145 SUN N LAKE BLVD STE A
SEBRING FL
33872-2131
US

V. Phone/Fax

Practice location:
  • Phone: 201-640-0696
  • Fax:
Mailing address:
  • Phone: 863-546-0030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: NANCY ESTHER HOLDER
Title or Position: TEAM LEADER
Credential: MD
Phone: 863-546-0030