Provider Demographics
NPI:1861478760
Name:FLOWER OF THE LAKE FAMILY PRACTICE, PA
Entity Type:Organization
Organization Name:FLOWER OF THE LAKE FAMILY PRACTICE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HAYDEN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:352-483-4400
Mailing Address - Street 1:PO BOX 1688
Mailing Address - Street 2:
Mailing Address - City:EUSTIS
Mailing Address - State:FL
Mailing Address - Zip Code:32727-1688
Mailing Address - Country:US
Mailing Address - Phone:352-483-4400
Mailing Address - Fax:352-357-8537
Practice Address - Street 1:720 N BAY ST
Practice Address - Street 2:
Practice Address - City:EUSTIS
Practice Address - State:FL
Practice Address - Zip Code:32726-2964
Practice Address - Country:US
Practice Address - Phone:352-483-4400
Practice Address - Fax:352-357-8537
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-22
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL80969OtherBLUECROSS BLUE SHIELD
FLK6186Medicare PIN