Healthcare Provider Details

I. General information

NPI: 1386426484
Provider Name (Legal Business Name): GO MEDICAL CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2023
Last Update Date: 09/05/2025
Certification Date: 09/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7345 JACKSON SPRINGS RD # C-2
TAMPA FL
33634-4754
US

IV. Provider business mailing address

7345 JACKSON SPRINGS RD STE C-2
TAMPA FL
33634-4754
US

V. Phone/Fax

Practice location:
  • Phone: 813-549-2940
  • Fax: 813-549-2942
Mailing address:
  • Phone: 813-549-2940
  • Fax: 813-549-2952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CYNTHIA LAYTON
Title or Position: PRACTICE MANAGER
Credential:
Phone: 210-442-9192