Myrtle Ridge Healthcare Center, LLC

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

Legal business name

MYRTLE RIDGE HEALTHCARE CENTER, LLC

Practice address

1539 Dale Mabry Hwy Ste 102
Lutz, FL 33548-3008

Phone

(813) 909-7102

NPI assigned

Mar 23, 2020

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Javier Gutierrez

Title

Executive Officer

Phone

(813) 997-9543

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1584921600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1584921600000",
    "number": "1376170225",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1539 DALE MABRY HWY STE 102",
            "city": "LUTZ",
            "state": "FL",
            "postal_code": "335483008"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1539 DALE MABRY HWY STE 102",
            "city": "LUTZ",
            "state": "FL",
            "postal_code": "335483008",
            "telephone_number": "813-909-7102"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MYRTLE RIDGE HEALTHCARE CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-03-23",
        "last_updated": "2020-03-23",
        "certification_date": "2020-03-23",
        "status": "A",
        "authorized_official_last_name": "GUTIERREZ",
        "authorized_official_first_name": "JAVIER",
        "authorized_official_title_or_position": "EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "813-997-9543"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Adult Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "102567000",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Robin Andrew Myers, DOM, A.P.
• Terrence Cameron Myers Jr., PHARMD
• Myofascial Release and Women'S Health LLC
• Callie Myrick
• Myrtle Ridge Family Medicine, PA
• Myrtle Ridge Primary Care, P.a
• Myrtle Ridge Primary Care, P.a
• N Shape & Health Medicine LLC
• Marie Louise Nace
• Jordan Michael Nagle

• Adult Health Nurse Practitioner in Lutz, FL
• Providers in Lutz, FL by specialty
• Adult Health Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.