| Adv An Ced Florida Medical Group, Corp. | |
|
3900 Broadway Ste D-9 Fort Myers FL 33901-8193 | |
| (239) 590-8570 | |
| Not Available |
| Full Name | Adv An Ced Florida Medical Group, Corp. |
|---|---|
| Speciality | Clinic/Center |
| Location | 3900 Broadway Ste D-9, Fort Myers, Florida |
| Authorized Official Name and Position | Odalis Maza Morejon (PRESIDENT) |
| Authorized Official Contact | 2395908570 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Adv An Ced Florida Medical Group, Corp. 3900 Broadway, Suite D-9 Fort Myers FL 33901 Ph: () - | Adv An Ced Florida Medical Group, Corp. 3900 Broadway Ste D-9 Fort Myers FL 33901-8193 Ph: (239) 590-8570 |
| NPI Number | 1376993980 |
|---|---|
| Provider Enumeration Date | 06/14/2016 |
| Last Update Date | 09/22/2016 |
| Medicare PECOS PAC ID | 4385079219 |
|---|---|
| Medicare Enrollment ID | O20200122002480 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376993980 | NPI | - | NPPES |
| 1649626409 | Other | FL | ARNP |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | HCC10633 (Florida) | Primary |
| Provider Name | Joaccy Lazo Reyes |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083226724 PECOS PAC ID: 5294137873 Enrollment ID: I20210706002825 |
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