Organization
CITRUS CARDIOVASCULAR ASSOCIATES PL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TREVA D. WIDDIS (ADMINISTRATOR)
(352) 787-9838
Entity
Organization
Contact information
Practice address
131 S CITRUS AVE, SUITE 305, INVERNESS, FL 34452-4701
(352) 637-0211
(352) 637-5733
Mailing address
700 DOCTORS CT, LEESBURG, FL 34748-7314
(352) 787-9838
(352) 787-8705
Taxonomy
Speciality
Code
Description
License number
State
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
269248100
—
FL
01
—
34906
BCBS OF FLORIDA
FL
Enumeration date
06/13/2006
Last updated
06/05/2020
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