=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154825677
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ZEPHYRHILLS FAMILY PRACTICE AND GERIATRIC CARE, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/20/2018
-----------------------------------------------------
Last Update Date | 03/30/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7213 GREEN SLOPE DR
-----------------------------------------------------
City | ZEPHYRHILLS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33541-1306
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-355-4917
-----------------------------------------------------
Fax | 855-547-5415
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 3268
-----------------------------------------------------
City | ZEPHYRHILLS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33539-3268
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-355-4914
-----------------------------------------------------
Fax | 855-547-5415
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | CYNTHIA BARRENTINE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 813-355-4914
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------