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General NPI Number Information
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NPI Number | 1528427150
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Entity Type | Organization
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Legal Business Name | WINTER HAVEN FAMILY PRACTICE, PA
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Dates
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Enumeration Date | 02/10/2016
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Last Update Date | 09/27/2016
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Provider Practice Location Address
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Address Line | 1130 1ST ST S
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City | WINTER HAVEN
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State | FL
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Zip | 33880-3903
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Country | US
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Telephone | 863-229-7486
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Fax | 863-280-6614
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Provider Business Mailing Address
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Address Line | 1130 1ST ST S
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City | WINTER HAVEN
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State | FL
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Zip | 33880-3903
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Country | US
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Telephone | 863-229-7486
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Fax | 863-280-6614
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JAIME ABUAN
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Credential | M.D.
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Telephone | 863-229-7486
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | ME90989
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License Number State | FL
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