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General NPI Number Information
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NPI Number | 1043252307
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Entity Type | Organization
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Legal Business Name | FLORIDA FACILITISTS, LLC
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Dates
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Enumeration Date | 06/12/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 1450 W LAKE BRANTLEY RD
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City | LONGWOOD
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State | FL
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Zip | 32779-4766
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Country | US
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Telephone | 321-273-0301
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Fax |
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Provider Business Mailing Address
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Address Line | 2000 PREVATT ST SUITE B3
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City | EUSTIS
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State | FL
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Zip | 32726-6149
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Country | US
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Telephone | 321-273-0301
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MR. JOHN HANSON RAUCH
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Credential |
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Telephone | 321-273-0301
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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