Provider Demographics
NPI:1730374711
Name:PESTANA PRIMARY CARE PLC
Entity type:Organization
Organization Name:PESTANA PRIMARY CARE PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASPREET
Authorized Official - Middle Name:KAUR
Authorized Official - Last Name:PESTANA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-781-7711
Mailing Address - Street 1:1840 MEASE DR
Mailing Address - Street 2:SUITE 315
Mailing Address - City:SAFETY HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34695-6602
Mailing Address - Country:US
Mailing Address - Phone:727-781-7711
Mailing Address - Fax:727-781-8711
Practice Address - Street 1:1840 MEASE DR
Practice Address - Street 2:SUITE 315
Practice Address - City:SAFETY HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34695-6602
Practice Address - Country:US
Practice Address - Phone:727-781-7711
Practice Address - Fax:727-781-8711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-12
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS9855207R00000X
FLME96774207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty