Organization
CYPRESS CREEK MEDICAL SPA
Active
Parent organization
FAMILYCARE OF LAND O LAKES, PA
Organization subpart
Yes
Provider details
NPI number
Legal business name
FAMILYCARE OF LAND O LAKES, PA
Authorized official
MRS. LINDA ROSEQUIST (PRACTICE ADMINISTRATOR)
(813) 948-3838
Entity
Organization
Contact information
Practice address
1942 HIGHLAND OAKS BLVD, SUITE A, LUTZ, FL 33559-7410
(813) 948-3838
(813) 949-0629
Mailing address
26827 FOGGY CREEK RD, SUITE 101A, WESLEY CHAPEL, FL 33544-6768
(813) 973-7774
(813) 973-8882
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0048283
FL
207R00000X
Internal Medicine Physician
0040424
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
34555
BLUE CROSS BLUE SHIELD OF FLORIDA
FL
01
—
CN4592
RAILROAD RETIREMENT
FL
Enumeration date
10/05/2011
Last updated
10/05/2011
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