Basic Information
| Provider Information | |||||||||
| NPI: | 1104364397 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | BAYCARE HEALTH SYSTEMS INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 201 1ST ST S | ||||||||
| Address2: | |||||||||
| City: | WINTER HAVEN | ||||||||
| State: | FL | ||||||||
| PostalCode: | 338803204 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8632947062 | ||||||||
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| Practice Location | |||||||||
| Address1: | 201 1ST ST S | ||||||||
| Address2: | |||||||||
| City: | WINTER HAVEN | ||||||||
| State: | FL | ||||||||
| PostalCode: | 338803204 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8632947062 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/07/2017 | ||||||||
| LastUpdateDate: | 02/07/2017 | ||||||||
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| AuthorizedOfficialLastName: | MORA | ||||||||
| AuthorizedOfficialFirstName: | YAZMIN | ||||||||
| AuthorizedOfficialMiddleName: | MAGNOLIA | ||||||||
| AuthorizedOfficialTitleorPosition: | LICENSED COUNSELOR | ||||||||
| AuthorizedOfficialTelephone: | 8632799742 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | LMHC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 101YM080 | FL | Y | Hospitals | General Acute Care Hospital |
No ID Information.