Provider Demographics
NPI:1649778663
Name:FLORIDA ADVANCED ACUPUNCTURE
Entity Type:Organization
Organization Name:FLORIDA ADVANCED ACUPUNCTURE
Other - Org Name:FLORIDA ADVANCED ACUPUNCTURE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:CAPRI
Authorized Official - Suffix:
Authorized Official - Credentials:DOM
Authorized Official - Phone:813-961-9174
Mailing Address - Street 1:14003 N DALE MABRY HWY
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33618-2459
Mailing Address - Country:US
Mailing Address - Phone:813-841-0337
Mailing Address - Fax:
Practice Address - Street 1:14003 N DALE MABRY HWY
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-2459
Practice Address - Country:US
Practice Address - Phone:813-841-0337
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-24
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP3890261QM2500X, 261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========OtherBLUE CROSS BLUE SHIELD