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General NPI Number Information
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NPI Number | 1982984134
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Entity Type | Organization
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Legal Business Name | ANGELHEART LLC
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Dates
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Enumeration Date | 08/19/2011
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Last Update Date | 08/19/2011
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Provider Practice Location Address
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Address Line | 3004 SEASONS BOULIVARD
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City | SARASOTA
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State | FL
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Zip | 34240
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Country | US
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Telephone | 941-894-7429
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Fax |
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Provider Business Mailing Address
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Address Line | 3004 SEASONS BLVD
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City | SARASOTA
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State | FL
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Zip | 34240-8230
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | MR. JEFFREY S LYONS
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Credential | DO
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Telephone | 941-894-7429
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | OS7077
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License Number State | FL
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