Provider Demographics
NPI:1205562998
Name:FIDELITY PREMIER GROUP INC
Entity type:Organization
Organization Name:FIDELITY PREMIER GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:MR
Authorized Official - First Name:FREDDY
Authorized Official - Middle Name:
Authorized Official - Last Name:DURAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-438-4338
Mailing Address - Street 1:11406 N DALE MABRY HWY STE 105
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33618-3879
Mailing Address - Country:US
Mailing Address - Phone:813-438-4338
Mailing Address - Fax:813-438-4968
Practice Address - Street 1:11406 N DALE MABRY HWY STE 105
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-3879
Practice Address - Country:US
Practice Address - Phone:813-438-4338
Practice Address - Fax:813-438-4968
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-26
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty