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General NPI Number Information
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NPI Number | 1407625395
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Entity Type | Organization
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Legal Business Name | INNOVACARE FLORIDA PHYSICIANS, LLC
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Dates
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Enumeration Date | 12/20/2023
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Last Update Date | 01/03/2025
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Provider Practice Location Address
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Address Line | 15689 SOUTHERN BLVD UNIT 101
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City | LOXAHATCHEE
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State | FL
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Zip | 33470-9229
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Country | US
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Telephone | 561-798-3030
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Fax | 561-798-8242
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Provider Business Mailing Address
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Address Line | 425 W COLONIAL DR STE 303
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City | ORLANDO
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State | FL
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Zip | 32804-6863
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Country | US
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Telephone | 321-332-6947
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Fax | 407-286-4515
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Authorized Official
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Title or Position | CREDENTIALING MANAGER
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Name | DAVID BROWN
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Credential |
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Telephone | 833-702-8383
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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 |
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License Number State |
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