Provider Demographics
NPI:1710434626
Name:FLORIDA FAMILY PRACTICE & URGENT CARE, LLC
Entity Type:Organization
Organization Name:FLORIDA FAMILY PRACTICE & URGENT CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:SALAZAR
Authorized Official - Last Name:MANALO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-838-5198
Mailing Address - Street 1:3450 E FLETCHER AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-4603
Mailing Address - Country:US
Mailing Address - Phone:813-812-4133
Mailing Address - Fax:813-501-3633
Practice Address - Street 1:3450 E FLETCHER AVE STE 100
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-4603
Practice Address - Country:US
Practice Address - Phone:813-812-4133
Practice Address - Fax:813-501-3633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-08
Last Update Date:2019-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL019212900Medicaid