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Myrtle Ridge Primary Care, P.a
Adult Health Nurse Practitioner in Lutz, Florida
NPI 1619504354

Myrtle Ridge Primary Care, P.a is an Adult Health Nurse Practitioner based in Lutz, FL and is specialized in Adult Health. Myrtle Ridge Primary Care, P.a practices in Lutz, FL. The NPI Number for Myrtle Ridge Primary Care, P.a is 1619504354 and holds a License No. (Florida).

The current practice location address for Myrtle Ridge Primary Care, P.a is 1539 Dale Mabry Hwy Ste 102, Lutz, FL and can be reached out via phone at 813-909-7102 and via fax at 813-909-0199.

Location: 1539 Dale Mabry Hwy Ste 102, Lutz, FL, 33548-3008
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1619504354
Provider Name
Myrtle Ridge Primary Care, P.a
Credential
Provider Entity Type
Organization
Address
1539 Dale Mabry Hwy Ste 102, Lutz, FL, 33548-3008
Phone Number
813-909-7102
Fax Number
813-909-0199
Provider Enumeration Date
03/24/2020
Last Update Date
03/13/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
108376100 05 FL
10D1050075 01 FL CLIA
107368700 05 FL
institution
Provider Business Practice Location Address Details
Address
1539 Dale Mabry Hwy Ste 102
City
Lutz
State
Florida
Zip
33548-3008
Phone Number
813-909-7102
Fax Number
813-909-0199
person
Provider Business Mailing Address Details
Address
1539 Dale Mabry Hwy Ste 102
City
Lutz
State
Florida
Zip
33548-3008
Phone Number
813-909-7102
Fax Number
813-909-0199
person
Provider's Taxonomy Details 1
Type
Allopathic & Osteopathic Physicians
Classification
Family Medicine
Speciality
Adult Medicine
Taxonomy
207QA0505X
License No.
()
Definition
Definition to come.
person
Provider's Taxonomy Details 2
Type
Agencies
Classification
Community/Behavioral Health
Speciality
-
Taxonomy
251S00000X
License No.
()
Definition
A private or public agency usually under local government jurisdiction, responsible for assuring the delivery of community based mental health, intellectual disabilities, substance abuse and/or behavioral health services to individuals with those disabilities. Services may range from companion care, respite, transportation, community integration, crisis intervention and stabilization, supported employment, day support, prevocational services, residential support, therapeutic and supportive consultation, environmental modifications, intensive in-home therapy and day treatment, in addition to traditional mental health and behavioral treatment.
person
Provider's Taxonomy Details 3
Type
Physician Assistants & Advanced Practice Nursing Providers
Classification
Nurse Practitioner
Speciality
Adult Health
Taxonomy
363LA2200X
License No.
()
Definition
Definition to come...
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