Healthcare Provider Details

I. General information

NPI: 1003036237
Provider Name (Legal Business Name): FLORIDA MEDICAL CLINIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2007
Last Update Date: 02/21/2020
Certification Date: 02/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17401 COMMERCE PARK BLVD STE 108
TAMPA FL
33647-3507
US

IV. Provider business mailing address

38135 MARKET SQ
ZEPHYRHILLS FL
33542-7505
US

V. Phone/Fax

Practice location:
  • Phone: 813-782-8311
  • Fax:
Mailing address:
  • Phone: 813-780-1255
  • Fax: 813-780-9773

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JOE I DELATORRE
Title or Position: CEO
Credential:
Phone: 813-780-8440