Organization
COMMUNITY PHYSICIANS OF NORTH PORT PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAMIE S WHIDDEN (OFFICE MANAGER)
(941) 423-5053
Entity
Organization
Contact information
Practice address
14400 TAMIAMI TRL, NORTH PORT, FL 34287-2703
(941) 423-5056
(941) 423-5068
Mailing address
14400 TAMIAMI TRL, NORTH PORT, FL 34287-2703
(941) 423-5056
(941) 423-5068
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
OS7878
FL
207R00000X
Internal Medicine Physician
Primary
ME 0066832
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0001242368
HUMANA
FL
01
—
10D0969781
CLIA
FL
01
—
20773
COLA
FL
01
—
338914
AETNA
—
01
—
77227
BCBS OF FLORIDA
FL
01
—
DE0739
PALMETTO/RAILROAD MEDICARE
FL
Enumeration date
02/07/2007
Last updated
02/10/2020
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