Organization
CAPRI EMERGENCY PHYSICIANS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER PROVASNIK (SUPERVISOR OF PROVIDER ENROLLMENT)
(800) 355-0808
Entity
Organization
Contact information
Practice address
14000 FIVAY RD, HUDSON, FL 34667-7103
(727) 869-5400
Mailing address
PO BOX 13894, PHILADELPHIA, PA 19101-3894
(800) 355-0808
(215) 834-2862
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
21795
BLUE SHIELD
FL
Enumeration date
07/05/2007
Last updated
04/20/2008
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