Provider Demographics
NPI:1629471826
Name:HEART HEALTH MANAGEMENT, LLC
Entity Type:Organization
Organization Name:HEART HEALTH MANAGEMENT, LLC
Other - Org Name:HEART HEALTH MANAGEMENT, LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:NP
Authorized Official - Prefix:MS
Authorized Official - First Name:CORINTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOBLACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-579-9589
Mailing Address - Street 1:2426 MARLEY CT
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32837-9132
Mailing Address - Country:US
Mailing Address - Phone:407-579-9589
Mailing Address - Fax:407-704-8493
Practice Address - Street 1:2426 MARLEY CT
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32837-9132
Practice Address - Country:US
Practice Address - Phone:407-579-9589
Practice Address - Fax:407-704-8493
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEART HEALTH MANAGEMENT, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-10-01
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLL08000044316261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1275591158Medicare UPIN