Organization
FLORIDA HEART & VASCULAR MULTI SPECIALTY GROUP, PA
Active
Organization
FLORIDA HEART & VASCULAR MULTI SPECIALTY GROUP, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACKIE FAUNDA (PHYSICIAN CREDENTIALING)
(352) 728-6808
Entity
Organization
Contact information
Practice address
1950 LAUREL MANOR DR, SUITE 142, THE VILLAGES, FL 32162-5603
(352) 326-7850
(352) 259-1605
Mailing address
511 MEDICAL PLAZA DR, SUITE 101, LEESBURG, FL 34748-7326
(352) 728-6808
(352) 728-3637
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207QG0300X
Geriatric Medicine (Family Medicine) Physician
—
—
207R00000X
Internal Medicine Physician
—
—
207RC0000X
Cardiovascular Disease Physician
Primary
—
—
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
—
—
207RI0011X
Interventional Cardiology Physician
—
—
207RN0300X
Nephrology Physician
—
—
208600000X
Surgery Physician
—
—
2086S0129X
Vascular Surgery Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
21798
BCBS OF FLORIDA
FL
01
—
695956
TUFTS
—
01
—
7194953
MAMSI
—
01
—
773114
MAILHANDLERS
—
01
—
CN9333
RR PALMETTO GBA
—
Enumeration date
05/08/2008
Last updated
05/08/2008
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