Healthcare Provider Details

I. General information

NPI: 1497688980
Provider Name (Legal Business Name): ST. LUKE PHYSICIAN PARTNERS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

199 AVE B NORTH WEST STE 310
WINTER HAVEN FL
33881
US

IV. Provider business mailing address

3616 HARDEN BLVD
LAKELAND FL
33803-5938
US

V. Phone/Fax

Practice location:
  • Phone: 863-284-5000
  • Fax: 863-284-1875
Mailing address:
  • Phone: 863-399-3365
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: MARIA DEL MAR FELIX MORALES,
Title or Position: MGR
Credential: MD
Phone: 863-399-3365