MEDICARE: BLUE HORIZON MEDICAL CLINIC L.L.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP2300X	Primary Care Nurse Practitioner

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235512138
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLUE HORIZON MEDICAL CLINIC L.L.C.

Provider Business Mailing Address
First Line	:	30701 WRENCREST DR
Second Line	:
City	:	WESLEY CHAPEL
State	:	FL
Zip	:	33543-7845
Country	:	US
Telephone Number	:	813-899-9797
Fax Number	:

Provider Business Practice Location Address
First Line	:	5101 E BUSCH BLVD STE 11
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33617-5380
Country	:	US
Telephone Number	:	813-899-9797
Fax Number	:	813-433-5553

Authorized Official
Title or Position	:	CEO, OWNER
Name	:	MRS. SHARON DENISE BLUE
Credential	:	DNP, APRN, ANP-C
Telephone Number	:	813-899-9797

Provider Enumeration Date	:	07/09/2015
Last Update Date	:	02/12/2025

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