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General NPI Number Information
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NPI Number | 1336493634
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Entity Type | Organization
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Legal Business Name | FLORIDA CARDIOCARE, PLLC
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Dates
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Enumeration Date | 11/08/2012
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Last Update Date | 11/08/2012
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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 | 352-854-4582
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Fax | 352-245-1162
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Provider Business Mailing 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 | 352-854-4582
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Fax | 352-245-1162
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Authorized Official
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Title or Position | PHYSICIAN/ OWNER
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Name | DR. JUSTIN FERNS
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Credential | MD
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Telephone | 352-854-4582
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | ME85309
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License Number State | FL
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