Healthcare Provider Details

I. General information

NPI: 1366862039
Provider Name (Legal Business Name): FLORIDA FAMILY PRIMARY CARE CENTERS OF TAMPA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2014
Last Update Date: 10/30/2023
Certification Date: 10/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11531 N 56TH ST #103
TEMPLE TERRACE FL
33617-2238
US

IV. Provider business mailing address

1400 NW 107TH AVE STE 500
SWEETWATER FL
33172-2746
US

V. Phone/Fax

Practice location:
  • Phone: 813-999-4963
  • Fax:
Mailing address:
  • Phone: 813-648-6684
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JOSE D SUAREZ
Title or Position: CMO
Credential:
Phone: 305-534-0076