Healthcare Provider Details

I. General information

NPI: 1538643291
Provider Name (Legal Business Name): FLORIDA PHYSICIANS PSN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2018
Last Update Date: 12/13/2023
Certification Date: 01/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6000 SW 74 STREET SECOND FLOOR
SOUTH MIAMI FL
33143-5068
US

IV. Provider business mailing address

6000 SW 74 STREET SECOND FLOOR
SOUTH MIAMI FL
33143-5068
US

V. Phone/Fax

Practice location:
  • Phone: 305-204-6433
  • Fax: 305-330-2486
Mailing address:
  • Phone: 305-542-8408
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. GEORGE M FERNANDEZ
Title or Position: PRESIDENT
Credential:
Phone: 305-542-8408