Provider Demographics
NPI:1235512138
Name:BLUE HORIZON MEDICAL CLINIC L.L.C.
Entity type:Organization
Organization Name:BLUE HORIZON MEDICAL CLINIC L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:BLUE
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, APRN, ANP-C
Authorized Official - Phone:813-899-9797
Mailing Address - Street 1:30701 WRENCREST DR
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33543-7845
Mailing Address - Country:US
Mailing Address - Phone:813-899-9797
Mailing Address - Fax:
Practice Address - Street 1:5101 E BUSCH BLVD STE 11
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33617-5380
Practice Address - Country:US
Practice Address - Phone:813-899-9797
Practice Address - Fax:813-433-5553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-09
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL008854200Medicaid