Provider Demographics
NPI:1235512138
Name:BLUE HORIZON MEDICAL CLINIC L.L.C.
Entity Type:Organization
Organization Name:BLUE HORIZON MEDICAL CLINIC L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ARNP-C, MSN
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:BLUE
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP-C, MSN
Authorized Official - Phone:813-808-2337
Mailing Address - Street 1:30701 WRENCREST DR
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33543-7845
Mailing Address - Country:US
Mailing Address - Phone:813-808-2337
Mailing Address - Fax:
Practice Address - Street 1:5101 E BUSCH BLVD
Practice Address - Street 2:STE 11
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33617-5380
Practice Address - Country:US
Practice Address - Phone:813-808-2337
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-09
Last Update Date:2022-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL008854200Medicaid