Healthcare Provider Details

I. General information

NPI: 1811177199
Provider Name (Legal Business Name): NORTH FLORIDA FOOT AND ANKLE ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2007
Last Update Date: 12/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6717 N.W. 11TH PLACE SUITE D
GAINESVILLE FL
32605
US

IV. Provider business mailing address

6717 N.W. 11TH PLACE SUITE D
GAINESVILLE FL
32605
US

V. Phone/Fax

Practice location:
  • Phone: 352-331-7543
  • Fax: 352-331-7756
Mailing address:
  • Phone: 352-331-7543
  • Fax: 352-331-7756

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPO1605
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPO2753
License Number StateFL

VIII. Authorized Official

Name: DR. TIMOTHY WHYATT
Title or Position: OWNER
Credential: DPM
Phone: 352-331-7543