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General NPI Number Information
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NPI Number | 1649124827
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Entity Type | Organization
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Legal Business Name | PALM MEDICAL CENTER LAKELAND LLC
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Dates
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Enumeration Date | 02/24/2026
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Last Update Date | 02/24/2026
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Provider Practice Location Address
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Address Line | 2416A LAND O LAKES BLVD
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City | LAND O LAKES
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State | FL
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Zip | 34639-4907
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Country | US
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Telephone | 813-949-8822
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Fax | 813-949-1103
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Provider Business Mailing Address
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Address Line | 2600 S DOUGLAS RD STE 308
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City | CORAL GABLES
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State | FL
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Zip | 33134-6134
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Country | US
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Telephone | 305-913-9454
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Fax | 305-442-1198
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Authorized Official
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Title or Position | CREDENTIALING MANAGER
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Name | CARMEL N BOSWELL
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Credential |
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Telephone | 813-538-7880
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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