Healthcare Provider Details

I. General information

NPI: 1770216483
Provider Name (Legal Business Name): HIGHLANDS NEPHROLOGY AND HYPERTENSION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2022
Last Update Date: 04/12/2024
Certification Date: 04/12/2024
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: 863-546-0030
  • 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 Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State

VIII. Authorized Official

Name: RAFAEL EUDARDO FRANJUL DIAZ
Title or Position: MANAGER
Credential: MD
Phone: 863-546-0030