# MYRTLE RIDGE HEALTHCARE CENTER, LLC

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

## Provider details

- **NPI number:** 1376170225
- **Authorized official:** JAVIER GUTIERREZ (EXECUTIVE OFFICER)
- **Authorized official phone:** (813) 997-9543

## Contact information

- **Practice address:** 1539 DALE MABRY HWY STE 102, LUTZ, FL 33548-3008
- **Practice address phone:** (813) 909-7102
- **Mailing address:** 1539 DALE MABRY HWY STE 102, LUTZ, FL 33548-3008

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LA2200X | Adult Health Nurse Practitioner | — | NULL | Yes |
| 363LA2200X | Adult Health Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 03/23/2020
- **Last updated:** 03/23/2020