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General NPI Number Information
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NPI Number | 1881347979
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Entity Type | Organization
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Legal Business Name | ALPHA DIABETES CENTER LLC
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Dates
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Enumeration Date | 01/31/2022
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Last Update Date | 01/31/2022
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Provider Practice Location Address
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Address Line | 5213 KEENE DR
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City | PLANT CITY
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State | FL
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Zip | 33566-9798
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Country | US
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Telephone | 813-441-2222
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Fax | 813-441-8467
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Provider Business Mailing Address
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Address Line | 302 S COLLINS ST # 198
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City | PLANT CITY
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State | FL
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Zip | 33563-5534
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Country | US
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Telephone | 813-441-4222
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | GWENDOLYN JAMES
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Credential | MSN
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Telephone | 813-441-4222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174H00000X
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Taxonomy Name | Health Educator
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 163WD0400X
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Taxonomy Name | Diabetes Educator Registered Nurse
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License Number |
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License Number State |
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