Healthcare Provider Details

I. General information

NPI: 1780513697
Provider Name (Legal Business Name): CARDIOMETABOLIC PRIMARY CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2026
Last Update Date: 05/16/2026
Certification Date: 05/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15407 IBIS FALL PL
SUN CITY CENTER FL
33573-6782
US

IV. Provider business mailing address

1201 6TH AVE W STE 100
BRADENTON FL
34205-7413
US

V. Phone/Fax

Practice location:
  • Phone: 239-692-1157
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: GUEDRY EDOUARD
Title or Position: OWNER
Credential: NP
Phone: 239-692-1157