Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Myrtle Ridge Primary Care, PA

Organization Case Management Agency · NPI 1700553633

Myrtle Ridge Primary Care, PA is a Case Management Agency in Lutz, Florida. Registered with an NPI since 2021.

In the registry since
2021
Specialties on file
2
What do these letters mean?
PA — Professional association
A form of business registration, not a clinical qualification.

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Practice location Address checks out

1539 Dale Mabry Hwy Ste 102
Lutz, FL 33548-3008
Phone: (813) 909-7102
Fax: (813) 909-0199
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Case Management Agency (primary) Taxonomy 251B00000X
Community Health Clinic/Center Taxonomy 261QC1500X

Record details

NPI number1700553633
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Yudaisy Mogena — Office Manager · (813) 909-7102
NPI enumeratedAugust 27, 2021
Last updated in NPPESMay 6, 2024
Certification dateMay 6, 2024
Mailing address1539 Dale Mabry Hwy Ste 102, Lutz, FL 33548-3008

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