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General NPI Number Information
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NPI Number | 1023347648
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Entity Type | Organization
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Legal Business Name | FLOWER OF THE LAKE FAMILY PRACTICE PA
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Dates
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Enumeration Date | 12/10/2009
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Last Update Date | 08/16/2010
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Provider Practice Location Address
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Address Line | 720 N BAY ST SUITE 5
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City | EUSTIS
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State | FL
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Zip | 32726-2964
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Country | US
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Telephone | 352-357-7200
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Fax | 352-357-7100
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Provider Business Mailing Address
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Address Line | 720 N BAY ST SUITE 5
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City | EUSTIS
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State | FL
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Zip | 32726-2964
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Country | US
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Telephone | 352-357-7200
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Fax | 352-357-7100
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. MARGARET HAYDEN
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Credential | DO
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Telephone | 352-357-7200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | OS6731
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License Number State | FL
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