Provider Demographics
NPI:1871184168
Name:FLORIDA FAMILY PRACTICE
Entity Type:Organization
Organization Name:FLORIDA FAMILY PRACTICE
Other - Org Name:MY WELLNESS PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:NP/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUMAIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:JAGVANI
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:954-439-4333
Mailing Address - Street 1:12525 ORANGE DR
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33330-4308
Mailing Address - Country:US
Mailing Address - Phone:954-439-4333
Mailing Address - Fax:
Practice Address - Street 1:12525 ORANGE DR
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33330-4308
Practice Address - Country:US
Practice Address - Phone:954-439-4333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-29
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care