Organization
PATIENT PROVIDER NETWORK LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL BAGBY (AMBR)
(727) 415-2308
Entity
Organization
Contact information
Practice address
1700 N DIXIE HWY STE 140, BOCA RATON, FL 33432-1808
(727) 415-2308
Mailing address
5260 78TH AVE N UNIT 1562, PINELLAS PARK, FL 33780-8062
(727) 415-2308
Taxonomy
Speciality
Code
Description
License number
State
133NN1002X
Nutrition Education Nutritionist
—
—
170300000X
Genetic Counselor (M.S.)
—
—
208D00000X
General Practice Physician
—
—
251B00000X
Case Management Agency
—
—
251E00000X
Home Health Agency
—
—
251J00000X
Nursing Care Agency
—
—
261QG0250X
Genetics Clinic/Center
—
—
261QH0100X
Health Service Clinic/Center
—
—
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
261QP2000X
Physical Therapy Clinic/Center
—
—
261QP2300X
Primary Care Clinic/Center
—
—
261QR0800X
Recovery Care Clinic/Center
—
—
261QV0200X
VA Clinic/Center
—
—
3336C0004X
Compounding Pharmacy
—
—
335E00000X
Prosthetic/Orthotic Supplier
—
—
Other
Enumeration date
12/13/2021
Last updated
04/24/2022
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