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Organization
PROFESSIONAL HEALTH CARE OF PINELLAS LLC
Active
Organization
PROFESSIONAL HEALTH CARE OF PINELLAS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CLAUDIA J POULIN (CREDENTIALING SPECIALIST)
(727) 820-1040
Entity
Organization
Contact information
Practice address
1839 CENTRAL AVE, ST PETERSBURG, FL 33713-8900
(727) 322-1054
(727) 822-8081
Mailing address
1839 CENTRAL AVE, ST PETERSBURG, FL 33713-8900
(727) 322-1054
(727) 822-8081
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
207RC0000X
Cardiovascular Disease Physician
—
—
207RG0100X
Gastroenterology Physician
—
—
207RH0002X
Hospice and Palliative Medicine (Internal Medicine) Physician
—
—
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
—
—
2084P0800X
Psychiatry Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
21639
BC FL PROV ID
FL
05
—
260904500
—
FL
01
—
CI3254
RAILROAD MEDICARE PROV ID
FL
Enumeration date
05/18/2006
Last updated
04/20/2026
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