Provider Demographics
NPI:1033774724
Name:MEDICAL TRANSITION CARE OF FLORIDA LLC
Entity Type:Organization
Organization Name:MEDICAL TRANSITION CARE OF FLORIDA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DEVON
Authorized Official - Middle Name:
Authorized Official - Last Name:PALMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-340-3533
Mailing Address - Street 1:2265 PICKFORD CIR
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32703-3371
Mailing Address - Country:US
Mailing Address - Phone:407-340-3533
Mailing Address - Fax:407-537-7778
Practice Address - Street 1:525 TECHNOLOGY PARK STE 109
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-7107
Practice Address - Country:US
Practice Address - Phone:407-340-3533
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-08
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care