# DAVITA MEDICAL GROUP FLORIDA CIN

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

## Provider details

- **NPI number:** 1669981858
- **Authorized official:** LAUREN EDGINGTON (CFO)
- **Authorized official phone:** (727) 824-0780

## Contact information

- **Practice address:** 2304 ALOMA AVE, WINTER PARK, FL 32792-3330
- **Practice address phone:** (407) 679-9222
- **Mailing address:** 10051 5TH ST N STE 200, ST PETERSBURG, FL 33702-2211

## Taxonomy

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

## Other

- **Enumeration date:** 09/20/2017
- **Last updated:** 09/20/2017