# ELLENTON FAMILY PRACTICE DIRECT PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1124471503
- **Authorized official:** MR. DAVID ALLAN HERVIG PA-C (OFFICE MANAGE AND PARTNER)
- **Authorized official phone:** (941) 730-5326

## Contact information

- **Practice address:** 907 25TH DR E, ELLENTON, FL 34222-2053
- **Practice address phone:** (941) 321-8299
- **Mailing address:** 907 25TH DR E, ELLENTON, FL 34222-2053
- **Mailing address phone:** (941) 417-7386

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | PA9102767 | FL | Yes |

## Other

- **Enumeration date:** 07/20/2016
- **Last updated:** 03/07/2023