Healthcare Provider Details

I. General information

NPI: 1184681355
Provider Name (Legal Business Name): GMS FLORIDA WEST COAST INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2006
Last Update Date: 08/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15320 AMBERLY DR SUITE B
TAMPA FL
33647-1647
US

IV. Provider business mailing address

15320 AMBERLY DR SUITE B
TAMPA FL
33647-1647
US

V. Phone/Fax

Practice location:
  • Phone: 813-977-0733
  • Fax: 813-971-2230
Mailing address:
  • Phone: 813-977-0733
  • Fax: 813-971-2230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateFL

VIII. Authorized Official

Name: MS. CYNDY EDKINS
Title or Position: CONTRACT MANAGER
Credential:
Phone: 813-977-0733