| Internal Medicine & Clinical Anti-aging Center Llc | |
|
5535 Grand Blvd Suite C New Port Richey FL 34652 | |
| (727) 841-0700 | |
| (727) 841-6969 |
| Full Name | Internal Medicine & Clinical Anti-aging Center Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 5535 Grand Blvd, New Port Richey, Florida |
| Authorized Official Name and Position | Florenda L. Fortner (M.D.) |
| Authorized Official Contact | 7278410700 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Internal Medicine & Clinical Anti-aging Center Llc 5535 Grand Blvd Suite C New Port Richey FL 34652 Ph: (727) 841-0700 | Internal Medicine & Clinical Anti-aging Center Llc 5535 Grand Blvd Suite C New Port Richey FL 34652 Ph: (727) 841-0700 |
| NPI Number | 1659567071 |
|---|---|
| Provider Enumeration Date | 09/19/2007 |
| Last Update Date | 03/02/2023 |
| Medicare PECOS PAC ID | 7012977416 |
|---|---|
| Medicare Enrollment ID | O20041011000561 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659567071 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | ME86987 (Florida) | Primary |
| Provider Name | Florenda L Fortner |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1891781126 PECOS PAC ID: 3375503774 Enrollment ID: I20041013000294 |
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