Provider Demographics
NPI:1346395688
Name:SUNSHINE HOME PHYSICIANS, LLC
Entity Type:Organization
Organization Name:SUNSHINE HOME PHYSICIANS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:PRIETO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-530-4606
Mailing Address - Street 1:12360 66TH ST
Mailing Address - Street 2:SUITE V1
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33773-3434
Mailing Address - Country:US
Mailing Address - Phone:727-530-4606
Mailing Address - Fax:727-231-0734
Practice Address - Street 1:12360 66TH ST
Practice Address - Street 2:SUITE V1
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33773-3434
Practice Address - Country:US
Practice Address - Phone:727-530-4606
Practice Address - Fax:727-231-0734
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0071110207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
2016545903OtherTAX IDENTIFICATION
FLK6785Medicare ID - Type Unspecified