Healthcare Provider Details

I. General information

NPI: 1134824154
Provider Name (Legal Business Name): INNOVACARE FLORIDA URGENT CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2023
Last Update Date: 03/31/2023
Certification Date: 03/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1037 S STATE ROAD 7 STE 113
WELLINGTON FL
33414-6139
US

IV. Provider business mailing address

6900 TAVISTOCK LAKES BLVD STE 300
ORLANDO FL
32827-7592
US

V. Phone/Fax

Practice location:
  • Phone: 561-798-3030
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: PENELOPE KOKKINIDES
Title or Position: CHIEF ADMINISTRATIVE OFFICER
Credential:
Phone: 201-270-7825