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General NPI Number Information
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NPI Number | 1801263983
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Entity Type | Organization
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Legal Business Name | HEALTHY FAMILY MEDICAL GROUP, LLC
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Dates
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Enumeration Date | 08/25/2015
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Last Update Date | 02/22/2016
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Provider Practice Location Address
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Address Line | 1138 NIKKI VIEW DR
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City | BRANDON
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State | FL
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Zip | 33511-4868
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Country | US
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Telephone | 813-393-1500
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Fax | 813-393-1501
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Provider Business Mailing Address
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Address Line | PO BOX 891293
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City | TAMPA
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State | FL
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Zip | 33689-1100
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Country | US
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Telephone | 813-393-1500
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Fax | 813-393-1501
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Authorized Official
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Title or Position | SECRETARY
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Name | JULIA BERESFORD
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Credential |
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Telephone | 340-642-3813
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 94636
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ACN415
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License Number State | FL
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