Basic Information
| Provider Information | |||||||||
| NPI: | 1316694144 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SYNERGIC HEALTHCARE SOLUTIONS LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3301 W GANDY BLVD | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336112931 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8139251903 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4949 4TH ST N | ||||||||
| Address2: | |||||||||
| City: | ST PETERSBURG | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337033800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8139251903 | ||||||||
| FaxNumber: | 8137498370 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/02/2022 | ||||||||
| LastUpdateDate: | 03/02/2022 | ||||||||
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| AuthorizedOfficialLastName: | DIECIDUE | ||||||||
| AuthorizedOfficialFirstName: | DARON | ||||||||
| AuthorizedOfficialMiddleName: | G. | ||||||||
| AuthorizedOfficialTitleorPosition: | MEMBER MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 8139251903 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 03/02/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | General Practice | 261QU0200X | Y | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care |
No ID Information.