Organization
BAYSIDE FAMILY HEALTHCARE CLEARWATER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PATRICK E HICKEY ARNP (MGRM)
(727) 504-7073
Entity
Organization
Contact information
Practice address
107 N MCMULLEN BOOTH RD, CLEARWATER, FL 33759-4450
(727) 504-7073
(813) 200-3313
Mailing address
107 N MCMULLEN BOOTH RD, CLEARWATER, FL 33759-4450
(727) 504-7073
(813) 200-3313
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
ME85120
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
274541100
—
FL
Enumeration date
10/06/2010
Last updated
10/06/2010
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