Provider Demographics
NPI:1417666538
Name:YOUR FAMILY DR LLC
Entity Type:Organization
Organization Name:YOUR FAMILY DR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ELAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:GUIMBARDA
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:786-879-4216
Mailing Address - Street 1:11961 N FLORIDA AVE STE A
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612-5213
Mailing Address - Country:US
Mailing Address - Phone:813-931-0333
Mailing Address - Fax:813-644-6919
Practice Address - Street 1:11961 N FLORIDA AVE STE A
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-5213
Practice Address - Country:US
Practice Address - Phone:813-931-0333
Practice Address - Fax:813-644-6919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-17
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty