Basic Information
| Provider Information | |||||||||
| NPI: | 1124551429 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PRIME HEALTH PARTNERS LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1694 BAYHILL DR | ||||||||
| Address2: | |||||||||
| City: | OLDSMAR | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346771956 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7274392677 | ||||||||
| FaxNumber: | 7274316870 | ||||||||
| Practice Location | |||||||||
| Address1: | 14100 US HIGHWAY 19 N | ||||||||
| Address2: | SUITE 132 | ||||||||
| City: | CLEARWATER | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337647241 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7274392677 | ||||||||
| FaxNumber: | 7274316870 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/04/2017 | ||||||||
| LastUpdateDate: | 04/13/2017 | ||||||||
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| AuthorizedOfficialLastName: | BONA | ||||||||
| AuthorizedOfficialFirstName: | ZEFF | ||||||||
| AuthorizedOfficialMiddleName: | RAFAEL | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7277871260 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 208100000X | OS6109 | FL | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
No ID Information.