Provider Demographics
NPI:1639285141
Name:FLORIDA INSTITUTE OF FAMILY MEDICINE, PA
Entity Type:Organization
Organization Name:FLORIDA INSTITUTE OF FAMILY MEDICINE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:B
Authorized Official - Last Name:NORSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-866-3166
Mailing Address - Street 1:1100 62ND AVE S
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33705-5620
Mailing Address - Country:US
Mailing Address - Phone:727-866-3166
Mailing Address - Fax:727-864-4043
Practice Address - Street 1:1100 62ND AVE S
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33705-5620
Practice Address - Country:US
Practice Address - Phone:727-866-3166
Practice Address - Fax:727-864-4043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2011-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL253079100Medicaid
21451BMedicare PIN
FL21451AMedicare PIN
FL21451Medicare PIN