Organization
ELLENTON FAMILY PRACTICE DIRECT PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAVID ALLAN HERVIG PA-C (OFFICE MANAGE AND PARTNER)
(941) 730-5326
Entity
Organization
Contact information
Practice address
907 25TH DR E, ELLENTON, FL 34222-2053
(941) 321-8299
Mailing address
907 25TH DR E, ELLENTON, FL 34222-2053
(941) 417-7386
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
PA9102767
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OS12316
LICENSE
FL
Enumeration date
07/20/2016
Last updated
03/07/2023
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