MYRTLE RIDGE PRIMARY CARE, P.A – NPI #1619504354
General Practice

A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions.

Health Care Provider Taxonomy Code for General Practice

MYRTLE RIDGE PRIMARY CARE, P.A is a provider located in LUTZ, FL. NPPES has assigned the NPI number 1619504354 to MYRTLE RIDGE PRIMARY CARE, P.A on March 24, 2020. It is a Type-2 NPI, indicating this NPI number is associated with an organization. With multiple taxonomy codes selected, the primary taxonomy selected by this provider is 208D00000X from the Health Care Provider Taxonomy code set, which is classified as General Practice.

The NPI profile was last updated on Jan 08, 2026. Use the NPI data found here to bill health insurance companies, identify providers enrolled in Medicare and Medicaid services or other HIPAA compliant transactions. See the complete NPI profile for MYRTLE RIDGE PRIMARY CARE, P.A below.

NPI Profile for
MYRTLE RIDGE PRIMARY CARE, P.A

NPI Number
1619504354
Enumeration Date

(more than 6 years ago)
Entity Type
Type-2  Organization
Organization health care providers may have a single employee or thousands of employees. An example is an incorporated individual who is an organization's only employee.
Legal Name
MYRTLE RIDGE PRIMARY CARE, P.A
Primary location
1539 DALE MABRY HWY STE 102
LUTZ, FL 33548-3008
Phone: (813) 909-7102 Fax: (813) 909-0199
Mailing address
Same as primary location
Organization Subpart
No
Authorized Official
YUDAISY MOGENA PADRON
OWNER
Phone: (813) 909-7102
Updated
Certification Date
Jan 08, 2026

Note: NPPES allows providers to attest to the accuracy of their NPI data. When a provider request any change to the NPI record, they will be able to attest to their changed NPI data, resulting in an updated certification date.

Identifiers

Identifiers for MYRTLE RIDGE PRIMARY CARE, P.A

Identifiers are used to associate other provider identifiers such as Medicaid or other insurers (ie:, Blue Cross, Blue Shield, Aetna, Kaiser-Permanente, etc.), with their NPI number. These identifiers can be used in matching an NPI number to an insurer's records. However, not all providers have such numbers and not all providers choose to include them in their NPI information.

DescriptionIssuerStateIdentifier
otherCLIAFL10D1050075
medicaidFL129484600
medicaidFL129485400
Taxonomy Code(s)

A taxonomy code is a code that describes the health care service provider's type, classification, and the area of specialization. The primary specialty for this provider is indicated as (Primary) below.

Taxonomy Classification / Specialization State License
208D00000X
- General Practice (Primary)
363A00000X
- Physician Assistant
103T00000X
- Psychologist
101YM0800X
- Counselor / Mental Health

The taxonomy codes are selected by the provider at the time of NPI registration. Selection of a taxonomy code does not replace any credentialing or validation process that the provider requesting the code should complete.