Healthcare Provider Details

I. General information

NPI: 1992328355
Provider Name (Legal Business Name): HAVEN PALLIATIVE CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2020
Last Update Date: 05/20/2020
Certification Date: 05/20/2020
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:
Mailing address:
  • Phone: 352-378-2121
  • Fax:

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 E TAYLOR
Title or Position: PRESIDENT
Credential: RN
Phone: 352-378-2121