Healthcare Provider Details

I. General information

NPI: 1780150524
Provider Name (Legal Business Name): WINTER HAVEN HOSPITAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2018
Last Update Date: 08/06/2024
Certification Date: 08/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 AVENUE F NE FL 2
WINTER HAVEN FL
33881-4131
US

IV. Provider business mailing address

2995 DREW STREET EAST BLDG 2ND FLOOR
CLEARWATER FL
33759
US

V. Phone/Fax

Practice location:
  • Phone: 863-293-1121
  • Fax:
Mailing address:
  • Phone: 727-281-9390
  • Fax: 813-635-2613

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number
License Number State

VIII. Authorized Official

Name: LYNDA A GORKEN
Title or Position: VP, PFS
Credential:
Phone: 727-281-9390