ELLENTON FAMILY PRACTICE DIRECT PLLC (NPI# 1124471503) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1124471503 |
| Entity Type | Organization |
| Organization Name | ELLENTON FAMILY PRACTICE DIRECT PLLC |
| Practice Address |
907 25th Dr E Ellenton FL 34222-2053 |
| Practice Telephone | 9413218299 |
| Mailing Telephone | 9414177386 |
| Enumeration Date | 2016-07-20 |
| Last Update Date | 2018-01-12 |
| Authorized Official Name | MR. DAVID ALLAN HERVIG (OFFICE MANAGE AND PARTNER) |
| Authorized Official Telephone | 9417305326 |
| Authorized Official Credential | PA-C |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | PA9102767 | FL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | DEA | FK4151433 | 01 |
| FL | LICENSE | OS12316 | 01 |
| Street Address |
907 25TH DR E |
| City | ELLENTON |
| State | FL |
| Zip Code | 34222-2053 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124371380 | North River Body Therapies | Massage Therapist | 907 25th Dr E, Ellenton, FL 34222-2053 | 2012-10-24 |
| 1710467147 | Renata Kulawik | Pharmacist | 907 25th Dr E, Ellenton, FL 34222-2053 | 2018-08-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346774585 | Pepharon Ciceron | Occupational Therapy Assistant | 5535 69th Pl E, Ellenton, FL 34222 | 2017-04-14 |
| 1104289131 | Marie Yvrose Saint-louis | Nurse's Aide | 5302 65 Terrace East, Ellenton, FL 34222 | 2016-03-29 |
| 1861608846 | Susan M Schoonmaker | Chiropractor | 7032 Us Hwy 301 North, Simple Relief Wellness Center, Ellenton, FL 34222 | 2007-05-15 |
| 1558374777 | Delynne Marie Murphy | Internal Medicine | 433 N. Us Hwy 301, Ellenton, FL 34222 | 2006-08-15 |
| 1942220124 | Ruben B. Hernandez | Internal Medicine | 4333 N. Hwy 301, Ellenton, FL 34222 | 2006-07-20 |
| 1073050688 | Jessica Laurent | Nurse Practitioner | 7915 Us Highway 301 N Ste 103, Ellenton, FL 34222 | 2017-01-21 |
| 1366873911 | Institute of Computerized Dentistry, Inc. | Dentist | 3030 Us Highway 301 N, Ellenton, FL 34222 | 2013-12-09 |
| 1932217205 | The Eye Associates of Manatee, LLP | Ophthalmology | 7915 Us Highway 301 N, Suite 101, Ellenton, FL 34222 | 2006-08-28 |
| 1952493264 | Vijayalakshmi Dhaduvai | Internal Medicine | 2901 Us Highway 301 N, Ellenton, FL 34222-2007 | 2006-09-28 |
| 1053345306 | Ashok Kumar Kumar Dhaduvai | Internal Medicine | 2901 Us Highway 301, Ellenton, FL 34222-2007 | 2006-07-11 |
| Find all providers in zip 34222 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548578560 | Dipti Ratilal Patil | Family Medicine | 4015 Us Highway 301 N, Ellenton, FL 34222-2407 | 2010-09-24 |
| 1770774267 | Katarzyna Zolkos | Family Medicine | 7915 Us 301 N Ste 103, Ellenton, FL 34222-3532 | 2007-08-08 |
| 1386641462 | Jonathan S Ware | Family Medicine | 6312 Us 301 N, Ellenton, FL 34222-3066 | 2005-07-05 |
| 1770597965 | David William Cain | Family Medicine | 4333 Us Highway 301 N, Ellenton, FL 34222-2413 | 2006-07-27 |
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| 1841891777 | Medical Risk Solutions LLC | Family Medicine | 455 Ishie Ave, Bronson, FL 32621-6204 | 2020-11-06 |
| 1801497953 | Wildwood Primary Care Associates | Family Medicine | 5814 Seven Mile Dr Ste 105, Wildwood, FL 34785-8869 | 2020-11-05 |
| 1053912238 | New Port Richey Primary Care Associates | Family Medicine | 4772 Us Highway 19, New Port Richey, FL 34652-4944 | 2020-11-04 |
| 1053912550 | Wound Integrity Florida Pa | Family Medicine | 111 Ne 1st St # 1011, Miami, FL 33132-2506 | 2020-11-03 |
| 1902407455 | Trek Healthcare LLC | Family Medicine | 11767 S Dixie Hwy # 208, Pinecrest, FL 33156-4438 | 2020-11-02 |
| 1700486933 | Orlando Jorge Diaz | Family Medicine | 6231 Sw 138th Ct Apt N, Miami, FL 33183-2095 | 2020-10-27 |
| 1255930871 | Haymee Rodriguez | Family Medicine | 18751 Sw 295th Ter, Homestead, FL 33030-2310 | 2020-10-23 |
| 1033718986 | Jason Wittlin | Family Medicine | 601 Sw 242nd Ter, Newberry, FL 32669-4495 | 2020-10-21 |
| 1457950420 | Paxton Medical Management | Family Medicine | 14279 Tamiami Trl, North Port, FL 34287-2215 | 2020-10-21 |
| 1679172779 | Flagler Family Nursing Home Care LLC | Family Medicine | 130 Healthpark Blvd, St Augustine, FL 32086-5776 | 2020-10-20 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.