=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447830070
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TORREYA HEALTH CARE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/08/2021
-----------------------------------------------------
Last Update Date | 12/12/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 17316 NORTHEAST STATE ROAD HIGHWAY 65
-----------------------------------------------------
City | HOSFORD
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32334
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-379-5800
-----------------------------------------------------
Fax | 850-379-5811
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 17316 NORTH EAST SR 65
-----------------------------------------------------
City | HOSFORD
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32334-1957
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-379-5800
-----------------------------------------------------
Fax | 850-379-5811
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/APRN
-----------------------------------------------------
Name | MR. STANLEY FRANKLIN WHITTAKER
-----------------------------------------------------
Credential | OWNER/APRN
-----------------------------------------------------
Telephone | 850-379-5800
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------