Healthcare Provider Details

I. General information

NPI: 1720494024
Provider Name (Legal Business Name): FOCUS-FL 1012 PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2014
Last Update Date: 07/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 S DALE MABRY HWY STE A6
TAMPA FL
33629-5837
US

IV. Provider business mailing address

510 LORNA SQ
HOOVER AL
35216-5480
US

V. Phone/Fax

Practice location:
  • Phone: 877-225-3542
  • Fax: 877-638-9903
Mailing address:
  • Phone: 877-225-3542
  • Fax: 877-638-9903

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: REGINA A HARDIN
Title or Position: MD
Credential:
Phone: 888-225-3542