Healthcare Provider Details

I. General information

NPI: 1083001481
Provider Name (Legal Business Name): PHYSICIAN PARTNERS OF AMERICA FLORIDA MEDICAL HOLDINGS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2015
Last Update Date: 06/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3450 E FLETCHER AVE SUITE 130
TAMPA FL
33613-4655
US

IV. Provider business mailing address

4730 N HABANA AVE SUITE 204
TAMPA FL
33614-7163
US

V. Phone/Fax

Practice location:
  • Phone: 813-549-2134
  • Fax: 813-870-1383
Mailing address:
  • Phone: 813-549-2134
  • Fax: 813-870-1383

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DAVID WOOD
Title or Position: MANAGER
Credential:
Phone: 813-549-2134