Healthcare Provider Details

I. General information

NPI: 1245580109
Provider Name (Legal Business Name): NORTH FLORIDA PLASTIC SURGERY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2012
Last Update Date: 09/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 NW 76TH DR STE A
GAINESVILLE FL
32607-6652
US

IV. Provider business mailing address

108 NW 76TH DR STE A
GAINESVILLE FL
32607-6652
US

V. Phone/Fax

Practice location:
  • Phone: 352-332-1150
  • Fax:
Mailing address:
  • Phone: 352-332-1150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number4901183
License Number StateFL

VIII. Authorized Official

Name: DR. JOHN W TYRONE
Title or Position: PRESIDENT
Credential: MD
Phone: 352-332-1150