Provider Demographics
NPI:1730496332
Name:FLORIDA IPA, INC.
Entity Type:Organization
Organization Name:FLORIDA IPA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NICOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:PAVOURIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-942-8900
Mailing Address - Street 1:1200 S PINELLAS AVE
Mailing Address - Street 2:SUITE 11
Mailing Address - City:TARPON SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34689-3728
Mailing Address - Country:US
Mailing Address - Phone:727-942-8900
Mailing Address - Fax:
Practice Address - Street 1:1200 S PINELLAS AVE
Practice Address - Street 2:SUITE 11
Practice Address - City:TARPON SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34689-3728
Practice Address - Country:US
Practice Address - Phone:727-942-8900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-03
Last Update Date:2010-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No251B00000XAgenciesCase Management