Provider Demographics
NPI:1801067517
Name:AMERICAN CARE OF NORTH FLORIDA, INC
Entity type:Organization
Organization Name:AMERICAN CARE OF NORTH FLORIDA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER SERVICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AGUEDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOUZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-278-0200
Mailing Address - Street 1:11211 N NEBRASKA AVE
Mailing Address - Street 2:SUITE A-5
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612-5777
Mailing Address - Country:US
Mailing Address - Phone:813-514-2333
Mailing Address - Fax:813-514-2216
Practice Address - Street 1:11211 N NEBRASKA AVE
Practice Address - Street 2:SUITE A-5
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-5777
Practice Address - Country:US
Practice Address - Phone:813-514-2333
Practice Address - Fax:813-514-2216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-20
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4940174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL4940OtherFACILITY LICENSE
FLK8488OtherMEDICARE