Provider Demographics
NPI:1982652285
Name:PREFERRED HEALTHCARE PA
Entity Type:Organization
Organization Name:PREFERRED HEALTHCARE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:FORD
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:352-357-7857
Mailing Address - Street 1:PO BOX 1330
Mailing Address - Street 2:
Mailing Address - City:EUSTIS
Mailing Address - State:FL
Mailing Address - Zip Code:32727-1330
Mailing Address - Country:US
Mailing Address - Phone:352-357-7857
Mailing Address - Fax:352-357-8537
Practice Address - Street 1:2000 PREVATT ST
Practice Address - Street 2:SUITE B
Practice Address - City:EUSTIS
Practice Address - State:FL
Practice Address - Zip Code:32726-6149
Practice Address - Country:US
Practice Address - Phone:352-357-7857
Practice Address - Fax:352-357-8537
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL38472OtherBCBS
FLK2987Medicare ID - Type Unspecified