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General NPI Number Information
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NPI Number | 1609297928
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Entity Type | Organization
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Legal Business Name | YOUR FAMILY WALK-IN CLINIC LLC
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Dates
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Enumeration Date | 01/05/2014
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Last Update Date | 08/02/2024
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Provider Practice Location Address
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Address Line | 17929 HUNTING BOW CIR
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City | LUTZ
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State | FL
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Zip | 33558-5378
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Country | US
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Telephone | 813-792-8555
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Fax |
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Provider Business Mailing Address
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Address Line | 17929 HUNTING BOW CIR
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City | LUTZ
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State | FL
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Zip | 33558-5378
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Country | US
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Telephone | 727-580-9131
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. LISA BRUNTON
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Credential | APRN
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Telephone | 813-792-8555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 2776972
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License Number State | FL
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