Provider Demographics
NPI:1720656523
Name:PRIMARY CARE AT HOME OF FLORIDA PLLC
Entity Type:Organization
Organization Name:PRIMARY CARE AT HOME OF FLORIDA PLLC
Other - Org Name:JASON C. CARDILLO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DNP
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:CARDILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-368-5494
Mailing Address - Street 1:6295 W SAMPLE RD UNIT 670783
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33067-5142
Mailing Address - Country:US
Mailing Address - Phone:954-621-8980
Mailing Address - Fax:
Practice Address - Street 1:5949 NW 24TH CT
Practice Address - Street 2:
Practice Address - City:MARGATE
Practice Address - State:FL
Practice Address - Zip Code:33063-1952
Practice Address - Country:US
Practice Address - Phone:954-621-8980
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-16
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1316472483OtherNPI JASON CARDILLO