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General NPI Number Information
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NPI Number | 1760070114
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Entity Type | Organization
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Legal Business Name | PLYMOUTH-SORRENTO MEDICAL CENTER
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Dates
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Enumeration Date | 12/31/2020
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Last Update Date | 01/12/2021
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Provider Practice Location Address
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Address Line | 30844 WESTRIDGE TER
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City | SORRENTO
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State | FL
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Zip | 32776-9356
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Country | US
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Telephone | 352-406-8583
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Fax |
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Provider Business Mailing Address
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Address Line | 24013 SORRENTO AVE
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City | SORRENTO
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State | FL
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Zip | 32776-9356
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Country | US
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Telephone | 352-406-8583
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MISS MARIE ALBERTE LABOSSIERE
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Credential | ARNP
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Telephone | 352-406-8583
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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