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General NPI Number Information
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NPI Number | 1750621538
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Entity Type | Organization
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Legal Business Name | FLORIDA FAMILY PHYSICIANS
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Dates
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Enumeration Date | 02/15/2013
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Last Update Date | 02/15/2013
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Provider Practice Location Address
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Address Line | 2840 N HIAWASSEE RD SUITE 428
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City | ORLANDO
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State | FL
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Zip | 32818-3319
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Country | US
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Telephone | 407-292-2200
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Fax | 407-292-8210
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Provider Business Mailing Address
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Address Line | PO BOX 951659
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City | LAKE MARY
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State | FL
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Zip | 32795-1659
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Country | US
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Telephone | 407-292-2200
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Fax | 407-292-8210
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Authorized Official
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Title or Position | OWNER
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Name | DR. JASVENDAR SINGH NANDRA
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Credential | M.D.
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Telephone | 407-921-2074
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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 | ME85696
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License Number State | FL
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