Healthcare Provider Details

I. General information

NPI: 1134895212
Provider Name (Legal Business Name): FLORIDA HOSPITAL PHYSICIAN GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2021
Last Update Date: 04/06/2022
Certification Date: 04/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3617 W HAMILTON AVE
TAMPA FL
33614-4055
US

IV. Provider business mailing address

3617 W HAMILTON AVE
TAMPA FL
33614-4055
US

V. Phone/Fax

Practice location:
  • Phone: 813-467-4265
  • Fax: 813-467-4267
Mailing address:
  • Phone: 813-467-4265
  • Fax: 813-467-4267

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number
License Number State

VIII. Authorized Official

Name: JAMES C PRESSWOOD
Title or Position: CFO
Credential:
Phone: 386-615-4237