MEDICARE: NORTH FLORIDA HEALTH CENTER, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1093593709
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH FLORIDA HEALTH CENTER, INC.

Provider Business Mailing Address
First Line	:	1372 OHIO AVE NORTH
Second Line	:
City	:	LIVE OAK
State	:	FL
Zip	:	32064
Country	:	US
Telephone Number	:	386-590-7096
Fax Number	:

Provider Business Practice Location Address
First Line	:	1373 OHIO AVE NORTH
Second Line	:
City	:	LIVE OAK
State	:	FL
Zip	:	32064
Country	:	US
Telephone Number	:	386-590-7096
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	JENNIFER LACASSE
Credential	:	LCSW
Telephone Number	:	386-590-7096

Provider Enumeration Date	:	09/15/2023
Last Update Date	:	10/06/2023

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