Basic Information
| Provider Information | |||||||||
| NPI: | 1265104335 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AMERICAN CARE OF NORTH FLORIDA, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12171 SW 268TH ST | ||||||||
| Address2: | |||||||||
| City: | HOMESTEAD | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330328001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3052780200 | ||||||||
| FaxNumber: | 3058514110 | ||||||||
| Practice Location | |||||||||
| Address1: | 1120 CARLTON AVE STE 1500 | ||||||||
| Address2: | |||||||||
| City: | LAKE WALES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 338534352 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8632704546 | ||||||||
| FaxNumber: | 8636386337 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/28/2021 | ||||||||
| LastUpdateDate: | 10/18/2021 | ||||||||
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| AuthorizedOfficialLastName: | BOUZA | ||||||||
| AuthorizedOfficialFirstName: | AGUEDA | ||||||||
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| AuthorizedOfficialTitleorPosition: | PROVIDER SERVICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 3052780200 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| NPICertificationDate: | 10/18/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.