Healthcare Provider Details

I. General information

NPI: 1164418919
Provider Name (Legal Business Name): CENTRAL FLORIDA HEALTH CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2005
Last Update Date: 10/25/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

417 CARLTON ST
WAUCHULA FL
33873-3405
US

IV. Provider business mailing address

950 COUNTY ROAD 17A W
AVON PARK FL
33825-2164
US

V. Phone/Fax

Practice location:
  • Phone: 863-773-0336
  • Fax: 863-773-6006
Mailing address:
  • Phone: 863-452-3000
  • Fax: 863-452-3069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: BERNARD FULSE
Title or Position: CFO
Credential:
Phone: 863-452-3000