Provider Demographics
NPI:1659888394
Name:AFFORDABLE PRIMARY CARE, LLC
Entity Type:Organization
Organization Name:AFFORDABLE PRIMARY CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:SHARON
Authorized Official - Last Name:PERROTT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-483-3730
Mailing Address - Street 1:1840 CLASSIQUE LN
Mailing Address - Street 2:
Mailing Address - City:TAVARES
Mailing Address - State:FL
Mailing Address - Zip Code:32778-5748
Mailing Address - Country:US
Mailing Address - Phone:352-483-3730
Mailing Address - Fax:352-508-9661
Practice Address - Street 1:1840 CLASSIQUE LN
Practice Address - Street 2:
Practice Address - City:TAVARES
Practice Address - State:FL
Practice Address - Zip Code:32778-5748
Practice Address - Country:US
Practice Address - Phone:352-483-3730
Practice Address - Fax:352-508-9661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-03
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0066695207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL375664500Medicaid
FLFP2223698OtherDEA