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General NPI Number Information
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NPI Number | 1538245709
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Entity Type | Organization
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Legal Business Name | FAMILY PRACTICE AND INJURY CENTER INC
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Dates
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Enumeration Date | 10/31/2006
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Last Update Date | 01/11/2020
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Provider Practice Location Address
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Address Line | 4701 CENTRAL AVE STE A
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City | SAINT PETERSBURG
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State | FL
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Zip | 33713-8153
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Country | US
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Telephone | 727-347-3213
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Fax | 727-345-6923
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Provider Business Mailing Address
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Address Line | 4701 CENTRAL AVE STE A
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City | SAINT PETERSBURG
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State | FL
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Zip | 33713-8153
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Country | US
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Telephone | 727-347-3213
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Fax | 727-345-6923
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | NILA J ALLEN
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Credential |
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Telephone | 727-347-3213
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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 | FLOS00004912
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License Number State | FL
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