Provider Demographics
NPI:1073521803
Name:CENTRAL FLORIDA ASSOCIATED PRIMARY CARE PHYSICIANS, PA
Entity Type:Organization
Organization Name:CENTRAL FLORIDA ASSOCIATED PRIMARY CARE PHYSICIANS, PA
Other - Org Name:HAWK & PUGLIA FAMILY PRACTICE PHYSICIANS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GLENNAJO
Authorized Official - Middle Name:
Authorized Official - Last Name:COURTNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-787-8301
Mailing Address - Street 1:101 S 11TH ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-5767
Mailing Address - Country:US
Mailing Address - Phone:352-787-8301
Mailing Address - Fax:352-787-6091
Practice Address - Street 1:101 S 11TH ST
Practice Address - Street 2:SUITE 4
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-5767
Practice Address - Country:US
Practice Address - Phone:352-787-8301
Practice Address - Fax:352-787-6091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL34152OtherBLUE CROSS BLUE SHIELD
FLCJ8048OtherRAILROAD MEDICARE
FL34152OtherBLUE CROSS BLUE SHIELD