Organization
MYRTLE RIDGE HEALTHCARE CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAVIER GUTIERREZ (EXECUTIVE OFFICER)
(813) 997-9543
Entity
Organization
Contact information
Practice address
1539 DALE MABRY HWY STE 102, LUTZ, FL 33548-3008
(813) 909-7102
Mailing address
1539 DALE MABRY HWY STE 102, LUTZ, FL 33548-3008
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
102567000
—
FL
Enumeration date
03/23/2020
Last updated
03/23/2020
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