Healthcare Provider Details

I. General information

NPI: 1407143316
Provider Name (Legal Business Name): HAVEN MEDICAL GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2011
Last Update Date: 08/01/2024
Certification Date: 08/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 NW 90TH BLVD
GAINESVILLE FL
32606-3809
US

IV. Provider business mailing address

4200 NW 90TH BLVD
GAINESVILLE FL
32606-3809
US

V. Phone/Fax

Practice location:
  • Phone: 352-378-2121
  • Fax: 352-379-6294
Mailing address:
  • Phone: 352-378-2121
  • Fax: 352-379-6294

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: PAULINE TAYLOR
Title or Position: PRESIDENT
Credential:
Phone: 407-682-0808