Healthcare Provider Details

I. General information

NPI: 1851344378
Provider Name (Legal Business Name): SOLANTIC/SOUTH FLORIDA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 11/02/2023
Certification Date: 11/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1205 N UNIVERSITY DR
CORAL SPRINGS FL
33071-6620
US

IV. Provider business mailing address

10151 DEERWOOD PARK BLVD STE 200
JACKSONVILLE FL
32256-0566
US

V. Phone/Fax

Practice location:
  • Phone: 954-780-8134
  • Fax: 954-227-2710
Mailing address:
  • Phone: 904-854-1545
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: WEBSTER GOLINKIN
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 919-550-0821