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General NPI Number Information
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NPI Number | 1275856064
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Entity Type | Organization
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Legal Business Name | HEART DOCTORS OF OCALA LLC
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Dates
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Enumeration Date | 03/08/2010
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Last Update Date | 12/16/2011
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Provider Practice Location Address
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Address Line | 10435 SE 170TH PL
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City | SUMMERFIELD
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State | FL
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Zip | 34491-8998
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Country | US
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Telephone | 352-347-8063
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Fax | 352-347-6187
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Provider Business Mailing Address
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Address Line | 2930 SE 31ST ST
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City | OCALA
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State | FL
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Zip | 34471-6287
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Country | US
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Telephone | 352-624-7384
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Fax | 352-624-1924
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. SONYA NASSER
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Credential |
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Telephone | 352-624-7384
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME85309
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | ME83972
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License Number State | FL
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