Healthcare Provider Details

I. General information

NPI: 1487769576
Provider Name (Legal Business Name): THE EHS MEDICAL PRACTICE PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 04/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

529 NE 60TH ST
GAINESVILLE FL
32607-2008
US

IV. Provider business mailing address

529 NE 60TH ST
GAINESVILLE FL
32607-2008
US

V. Phone/Fax

Practice location:
  • Phone: 352-331-5100
  • Fax:
Mailing address:
  • Phone: 352-331-5100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME 161274
License Number StateFL

VIII. Authorized Official

Name: MS. DONNA J HOVER
Title or Position: NURSE
Credential: LPN
Phone: 352-331-5100