Provider Demographics
NPI:1952768582
Name:PHYSICIAN NEXT DOOR
Entity Type:Organization
Organization Name:PHYSICIAN NEXT DOOR
Other - Org Name:PHYSICIAN NEXT DOOR POINCIANA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JACKIE
Authorized Official - Middle Name:
Authorized Official - Last Name:FUENTES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-546-3714
Mailing Address - Street 1:1969 S ALAFAYA TRL # 128
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-8732
Mailing Address - Country:US
Mailing Address - Phone:407-343-0542
Mailing Address - Fax:407-343-0553
Practice Address - Street 1:339 CYPRESS PKWY STE 110
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34759-3315
Practice Address - Country:US
Practice Address - Phone:407-343-0542
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PHYSICIAN NEXT DOOR
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-01-27
Last Update Date:2016-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
No305S00000XManaged Care OrganizationsPoint of Service