Provider Demographics
NPI:1043550452
Name:FLORIDA FAMILY PHYSICIANS
Entity Type:Organization
Organization Name:FLORIDA FAMILY PHYSICIANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASVENDAR
Authorized Official - Middle Name:SINGH
Authorized Official - Last Name:NANDRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-921-2074
Mailing Address - Street 1:PO BOX 951659
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32795-1659
Mailing Address - Country:US
Mailing Address - Phone:407-921-2074
Mailing Address - Fax:407-264-8686
Practice Address - Street 1:255 CITRUS TOWER BLVD
Practice Address - Street 2:SUITE 206
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-2756
Practice Address - Country:US
Practice Address - Phone:352-242-9600
Practice Address - Fax:352-242-9605
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FLORIDA FAMILY PHYSICIANS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-02-21
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME85696261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLH52143Medicare UPIN