Healthcare Provider Details

I. General information

NPI: 1982688628
Provider Name (Legal Business Name): NORTH FLORIDA SURGICAL ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2005
Last Update Date: 11/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1121 NW 64TH TER SUITE B
GAINESVILLE FL
32605-4243
US

IV. Provider business mailing address

2000 HEALTH PARK DR
BRENTWOOD TN
37027-4525
US

V. Phone/Fax

Practice location:
  • Phone: 352-331-3583
  • Fax: 352-331-3669
Mailing address:
  • Phone: 615-372-5426
  • Fax: 866-831-4898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: JOHN MARK RODKEY
Title or Position: VICE PRESIDENT
Credential:
Phone: 850-523-3816