Provider Demographics
NPI:1114630803
Name:AMERICAN CARE OF NORTH FLORIDA, INC
Entity Type:Organization
Organization Name:AMERICAN CARE OF NORTH FLORIDA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER SERVICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AGUEDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOUZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-278-0200
Mailing Address - Street 1:12171 SW 268TH ST
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-8001
Mailing Address - Country:US
Mailing Address - Phone:305-278-0200
Mailing Address - Fax:305-851-4110
Practice Address - Street 1:2001 49TH ST S
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:FL
Practice Address - Zip Code:33707-4915
Practice Address - Country:US
Practice Address - Phone:727-220-4423
Practice Address - Fax:727-291-0053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-28
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL012077100Medicaid