Provider Demographics
NPI:1346678901
Name:SNF PROFESSIONAL PHYSICIANS OF FLORIDA LLC
Entity Type:Organization
Organization Name:SNF PROFESSIONAL PHYSICIANS OF FLORIDA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:R
Authorized Official - Last Name:GLOVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-412-5962
Mailing Address - Street 1:117 CELEBRATION BLVD
Mailing Address - Street 2:
Mailing Address - City:CELEBRATION
Mailing Address - State:FL
Mailing Address - Zip Code:34747-5009
Mailing Address - Country:US
Mailing Address - Phone:407-900-0390
Mailing Address - Fax:
Practice Address - Street 1:117 CELEBRATION BLVD
Practice Address - Street 2:
Practice Address - City:CELEBRATION
Practice Address - State:FL
Practice Address - Zip Code:34747-5009
Practice Address - Country:US
Practice Address - Phone:407-900-0390
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-17
Last Update Date:2013-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty