Provider Demographics
NPI:1396411310
Name:CARE ONE OF FLORIDA LLC
Entity Type:Organization
Organization Name:CARE ONE OF FLORIDA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:STACIE
Authorized Official - Middle Name:S
Authorized Official - Last Name:LAVIANO
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:352-432-0817
Mailing Address - Street 1:12220 CORTEZ BLVD
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34613-2631
Mailing Address - Country:US
Mailing Address - Phone:352-556-5216
Mailing Address - Fax:
Practice Address - Street 1:11115 COUNTY LINE RD
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34609-5615
Practice Address - Country:US
Practice Address - Phone:352-683-1982
Practice Address - Fax:352-683-1077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-19
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL307544300Medicaid