Provider Demographics
NPI:1679506620
Name:FLORIDA HOSPITAL HOME INFUSION-WATERMAN
Entity Type:Organization
Organization Name:FLORIDA HOSPITAL HOME INFUSION-WATERMAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:HUGH
Authorized Official - Last Name:GARNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-865-5489
Mailing Address - Street 1:2250 HUFFSTETLER WAY
Mailing Address - Street 2:
Mailing Address - City:TAVARES
Mailing Address - State:FL
Mailing Address - Zip Code:32778-5264
Mailing Address - Country:US
Mailing Address - Phone:352-742-8940
Mailing Address - Fax:352-742-8941
Practice Address - Street 1:2250 HUFFSTETLER WAY
Practice Address - Street 2:
Practice Address - City:TAVARES
Practice Address - State:FL
Practice Address - Zip Code:32778-5264
Practice Address - Country:US
Practice Address - Phone:352-742-8940
Practice Address - Fax:352-742-8941
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH16288333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0510120002Medicare ID - Type UnspecifiedMEDICARE PROVIDER ID