# FLORIDA HEART & VASCULAR GROUP, PA

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- **Entity:** Organization
- **Status:** Active
- **Other names:** LEESBURG FAMILY MEDICINE
- **Organization subpart:** No

## Provider details

- **NPI number:** 1225284391
- **Authorized official:** REGINA INGRAM (ADMINISTRATOR)
- **Authorized official phone:** (352) 728-6808

## Contact information

- **Practice address:** 201 LAGRANDE BLVD, LADY LAKE, FL 32159-1303
- **Practice address phone:** (352) 753-0606
- **Mailing address:** 201 LAGRANDE BLVD, LADY LAKE, FL 32159-1303
- **Mailing address phone:** (352) 753-0606

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 207QG0300X | Geriatric Medicine (Family Medicine) Physician | — | NULL | — |
| 207QG0300X | Geriatric Medicine (Family Medicine) Physician | — | — | — |

## Other

- **Enumeration date:** 08/08/2008
- **Last updated:** 08/08/2008