Healthcare Provider Details

I. General information

NPI: 1780478917
Provider Name (Legal Business Name): HUMANITARY MEDICAL CENTER WINTER HAVEN INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2025
Last Update Date: 04/04/2025
Certification Date: 04/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 1ST ST S STE 101
WINTER HAVEN FL
33880-3266
US

IV. Provider business mailing address

3109 W DR MLK BLVD STE 121
TAMPA FL
33607-6240
US

V. Phone/Fax

Practice location:
  • Phone: 813-499-1500
  • Fax: 813-499-1499
Mailing address:
  • Phone: 813-468-1866
  • Fax: 813-499-1499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ELIECER GONZALEZ
Title or Position: PRESIDENT
Credential:
Phone: 813-468-1866