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General NPI Number Information
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NPI Number | 1699318840
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Entity Type | Organization
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Legal Business Name | PALMETTO PRIMARY CARE ASSOCIATES, LLC
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Dates
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Enumeration Date | 10/21/2019
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Last Update Date | 10/21/2019
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Provider Practice Location Address
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Address Line | 1003 17TH ST W
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City | PALMETTO
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State | FL
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Zip | 34221-3021
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Country | US
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Telephone | 813-269-6426
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Fax | 813-342-5261
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Provider Business Mailing Address
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Address Line | 6101 WEBB RD STE 203
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City | TAMPA
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State | FL
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Zip | 33615-2865
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Country | US
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Telephone | 813-269-6426
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Fax | 813-342-5261
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Authorized Official
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Title or Position | ADMIN
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Name | JEANINE PEREZ
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Credential |
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Telephone | 813-269-6426
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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 |
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License Number State |
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