Healthcare Provider Details

I. General information

NPI: 1578717641
Provider Name (Legal Business Name): HEALTHCARE PROVIDERS OF FLORIDA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2008
Last Update Date: 11/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 CITRUS OAKS RUN
WINTER SPRINGS FL
32708-4800
US

IV. Provider business mailing address

1120 CITRUS OAKS RUN
WINTER SPRINGS FL
32708-4800
US

V. Phone/Fax

Practice location:
  • Phone: 407-716-6443
  • Fax: 407-359-1217
Mailing address:
  • Phone: 407-716-6443
  • Fax: 407-359-1217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number1027292
License Number StateFL

VIII. Authorized Official

Name: MS. PAMELA LYNN FLAHERTY
Title or Position: PRESIDENT
Credential: ARNP
Phone: 407-716-6443