Provider Demographics
NPI:1639289036
Name:PRINCETON PROFESSIONAL SERVICES
Entity type:Organization
Organization Name:PRINCETON PROFESSIONAL SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOROFFICER
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:STILTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-691-8200
Mailing Address - Street 1:600 COURTLAND ST
Mailing Address - Street 2:# 300
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-1332
Mailing Address - Country:US
Mailing Address - Phone:407-691-8200
Mailing Address - Fax:407-691-8222
Practice Address - Street 1:600 COURTLAND ST
Practice Address - Street 2:# 300
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-1332
Practice Address - Country:US
Practice Address - Phone:407-691-8200
Practice Address - Fax:407-691-8222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL20383096251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL107211OtherUNISON HEALTH PLAN MCR
FL107211OtherEVERCARE MCR
FL107211OtherHUMANA GOLD CHC MCR
FL107211OtherPACIFICARE MCR
FLH56OtherBLUE CROSS BLUE SHIELD OF
FLHIGHMARK BCBS MCROther107211
FL107211OtherUNITED HEALTHCARE
FL107211OtherWELLCARE MCR
FLAMERIGROUPOther115555
FLH56OtherBLUE CROSS BLUE SHIELD OF
FL=========001OtherTRICARE