Provider Demographics
NPI:1447098934
Name:ADDRESS HEALTHCARE OF FLORIDA PLLC
Entity type:Organization
Organization Name:ADDRESS HEALTHCARE OF FLORIDA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:WACKSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:855-232-0644
Mailing Address - Street 1:8348 LITTLE ROAD
Mailing Address - Street 2:STE 149
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34654-4919
Mailing Address - Country:US
Mailing Address - Phone:855-232-0644
Mailing Address - Fax:888-546-0488
Practice Address - Street 1:8348 LITTLE RD STE 149
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34654-4919
Practice Address - Country:US
Practice Address - Phone:855-232-0644
Practice Address - Fax:888-546-0488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-18
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty