Healthcare Provider Details

I. General information

NPI: 1093829442
Provider Name (Legal Business Name): PREMIER MEDICAL ASSOCIATES ALL FLORIDA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 11/16/2022
Certification Date: 11/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1580 SANTA BARBARA BLVD SUITE C
THE VILLAGES FL
32159
US

IV. Provider business mailing address

1580 SANTA BARBARA BLVD
THE VILLAGES FL
32159-6827
US

V. Phone/Fax

Practice location:
  • Phone: 352-259-2159
  • Fax: 352-259-5731
Mailing address:
  • Phone: 352-259-2159
  • Fax: 352-674-4386

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME0069935
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberME95629
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberARNP3378652
License Number StateFL

VIII. Authorized Official

Name: CYNTHIA ROMSKA
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 352-259-2159