Provider Demographics
NPI:1013341429
Name:SUNSHINE STATE FAMILY CARE PA
Entity Type:Organization
Organization Name:SUNSHINE STATE FAMILY CARE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA-AMILL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-631-9396
Mailing Address - Street 1:16144 CHURCHVIEW DR
Mailing Address - Street 2:BUILDING A, SUITE 109
Mailing Address - City:LITHIA
Mailing Address - State:FL
Mailing Address - Zip Code:33547-3851
Mailing Address - Country:US
Mailing Address - Phone:813-631-9396
Mailing Address - Fax:
Practice Address - Street 1:16144 CHURCHVIEW DR
Practice Address - Street 2:BUILDING A, SUITE 109
Practice Address - City:LITHIA
Practice Address - State:FL
Practice Address - Zip Code:33547-3851
Practice Address - Country:US
Practice Address - Phone:813-631-9396
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-22
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME105665207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCT330AMedicare PIN