Provider Demographics
NPI:1932581071
Name:PHYSICIAN PARTNERS OF AMERICA FLORIDA MEDICAL HOLDINGS LLC
Entity Type:Organization
Organization Name:PHYSICIAN PARTNERS OF AMERICA FLORIDA MEDICAL HOLDINGS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-549-2134
Mailing Address - Street 1:4730 N HABANA AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-7163
Mailing Address - Country:US
Mailing Address - Phone:813-549-2134
Mailing Address - Fax:813-870-1383
Practice Address - Street 1:4730 N HABANA AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-7163
Practice Address - Country:US
Practice Address - Phone:813-549-2134
Practice Address - Fax:813-870-1383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-25
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty