Organization
FLORIDA HEART & VASCULAR MULTI SPECIALTY GROUP PA
Active
Other names
Florida Heart & Vascular Center
Organization subpart
No
Provider details
NPI number
Authorized official
JACKIE FAUNDA (PHYSICIAN CREDENTIALING)
(352) 728-6808
Entity
Organization
Contact information
Practice address
511 MEDICAL PLAZA DR, SUITE 101, LEESBURG, FL 34748-7326
(352) 728-6808
(352) 728-1743
Mailing address
511 MEDICAL PLAZA DR, SUITE 101, LEESBURG, FL 34748-7326
(352) 728-6808
(352) 728-1743
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207QG0300X
Geriatric Medicine (Family Medicine) Physician
—
—
207RC0000X
Cardiovascular Disease Physician
Primary
—
—
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
—
—
207RI0011X
Interventional Cardiology Physician
—
—
207RN0300X
Nephrology Physician
—
—
207UN0901X
Nuclear Cardiology Physician
—
—
208600000X
Surgery Physician
—
—
2086S0129X
Vascular Surgery Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
21798
BCBS FLORIDA
FL
05
—
255260400
—
FL
01
—
695956
TUFTS
—
01
—
773114
MAILHANDLERS
—
01
—
7914953
MAMSI
—
01
—
CN9333
GBA RR PALMETTO
—
Enumeration date
08/31/2005
Last updated
09/13/2013
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