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General NPI Number Information
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NPI Number | 1073735833
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Entity Type | Organization
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Legal Business Name | FAMILY CARE OF LAND O LAKES PA
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Dates
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Enumeration Date | 05/02/2007
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Last Update Date | 05/04/2011
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Provider Practice Location Address
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Address Line | 1942 HIGHLAND OAKS BLVD SUITE A
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City | LUTZ
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State | FL
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Zip | 33559-7410
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Country | US
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Telephone | 813-948-3838
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Fax | 813-949-0629
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Provider Business Mailing Address
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Address Line | 1942 HIGHLAND OAKS BLVD SUITE A
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City | LUTZ
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State | FL
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Zip | 33559-7410
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Country | US
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Telephone | 813-948-3838
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Fax | 813-949-0629
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Authorized Official
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Title or Position | OWNER
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Name | MR. ROBERT BRUCE ROSEQUIST
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Credential | MD
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Telephone | 813-948-3838
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 0048283
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME20601
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 0040424
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License Number State | FL
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