Organization
CHULUOTA CLINIC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL GEORGE PRUNER ARNP (OWNER)
(407) 542-7961
Entity
Organization
Contact information
Practice address
107 8TH ST W, CHULUOTA, FL 32766-8924
(407) 542-7961
Mailing address
107 8TH ST W, CHULUOTA, FL 32766-8924
(407) 542-7961
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
182428
FL
Other
Enumeration date
10/26/2012
Last updated
10/26/2012
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