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General NPI Number Information
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NPI Number | 1801839683
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Entity Type | Organization
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Legal Business Name | CITRUS CARDIOVASCULAR ASSOCIATES PL
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Dates
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Enumeration Date | 06/13/2006
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Last Update Date | 06/05/2020
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Provider Practice Location Address
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Address Line | 131 S CITRUS AVE SUITE 305
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City | INVERNESS
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State | FL
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Zip | 34452-4701
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Country | US
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Telephone | 352-637-0211
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Fax | 352-637-5733
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Provider Business Mailing Address
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Address Line | 700 DOCTORS CT
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City | LEESBURG
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State | FL
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Zip | 34748-7314
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Country | US
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Telephone | 352-787-9838
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Fax | 352-787-8705
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | TREVA D. WIDDIS
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Credential |
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Telephone | 352-787-9838
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number |
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License Number State |
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