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MYRTLE RIDGE HEALTHCARE CENTER, LLC
NPI 1376170225
Nurse Practitioner - Adult Health in Lutz, FL

Active since March 23, 2020
1539 DALE MABRY HWY STE 102, LUTZ, FL 33548(813) 909-7102 Get Directions Write a Review

NPPES record last updated: March 23, 2020. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Myrtle Ridge Healthcare Center, Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MYRTLE RIDGE HEALTHCARE CENTER, LLC (NPI 1376170225) is a healthcare organization registered as an adult health in Lutz, Florida and active in the NPI registry since March 2020. The organization lists Javier Gutierrez, Executive Officer, as its authorized official.

NPPES Registry Identity

NPI1376170225
Entity TypeOrganization
Primary Taxonomy363LA2200X
Legal Business NameMYRTLE RIDGE HEALTHCARE CENTER, LLC
Location Address1539 DALE MABRY HWY STE 102Lutz, FL 33548-3008
Mailing Address1539 Dale Mabry Hwy Ste 102Lutz, FL 33548-3008
Phone(813) 909-7102
Organization SubpartNo
Authorized OfficialJavier GutierrezExecutive Officer · (813) 997-9543
Enumeration DateMarch 23, 2020
NPPES CertifiedMarch 23, 2020
✔ NPI 1376170225 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · Adult HealthPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LA2200X
1539 DALE MABRY HWY STE 102, Lutz, FL 33548
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Other Identifiers 1

Medicaid102567000FL

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Other Providers at the Same Location NPPES 8

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

TANIABEX LOPEZ GARCIA MSW
Social Worker
1539 DALE MABRY HWY STE 102
LUTZ, FL 33548
Hillsborough County (813) 909-7102
JACK ALTON BERGH MD
Family Medicine
1539 DALE MABRY HWY STE 102
LUTZ, FL 33548
Hillsborough County (813) 909-7102
GEORGE MARCEL DORTA CHAPIN PA
Physician Assistant
1539 DALE MABRY HWY STE 102
LUTZ, FL 33548
Hillsborough County (813) 909-7102
RAUL MEDINA ROJO MSN, APRN, PMHNP-BC
Nurse Practitioner (Psychiatric/Mental Health)
1539 DALE MABRY HWY STE 102
LUTZ, FL 33548
Hillsborough County (813) 909-7102
MYRTLE RIDGE PRIMARY CARE, P.A
General Practice
1539 DALE MABRY HWY STE 102
LUTZ, FL 33548
Hillsborough County (813) 909-7102
MYRTLE RIDGE PRIMARY CARE, P.A
Case Management
1539 DALE MABRY HWY STE 102
LUTZ, FL 33548
Hillsborough County (813) 909-7102
MRS. YUDAISY MOGENA PADRON PA
Physician Assistant
1539 DALE MABRY HWY STE 102
LUTZ, FL 33548
Hillsborough County (813) 909-7102
DAYANA FERNANDEZ-PACHECO GORRIN CBHCMS
Case Manager/Care Coordinator
1539 DALE MABRY HWY STE 102
LUTZ, FL 33548
Hillsborough County (813) 909-7102

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Myrtle Ridge Healthcare Center, LLC's NPI number?

The NPI number for Myrtle Ridge Healthcare Center, LLC is 1376170225. It was assigned to this organization in the NPPES registry on March 23, 2020.

Where is Myrtle Ridge Healthcare Center, LLC located?

Myrtle Ridge Healthcare Center, LLC is located at 1539 Dale Mabry Hwy Ste 102, Lutz, FL 33548. The listed phone number is (813) 909-7102.

What is Myrtle Ridge Healthcare Center, LLC's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Adult Health, with taxonomy code 363LA2200X.

When was this NPI record last updated?

The NPPES record for Myrtle Ridge Healthcare Center, LLC was last updated on March 23, 2020. NPI Profile syncs with the weekly NPPES data releases published by CMS.