Healthcare Provider Details

I. General information

NPI: 1982143079
Provider Name (Legal Business Name): CELEBRATE PRIMARY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2017
Last Update Date: 02/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 NW 23RD AVE STE B
GAINESVILLE FL
32606-6562
US

IV. Provider business mailing address

4400 NW 23RD AVE STE B
GAINESVILLE FL
32606-6562
US

V. Phone/Fax

Practice location:
  • Phone: 352-474-8686
  • Fax:
Mailing address:
  • Phone: 352-474-8686
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number StateFL

VIII. Authorized Official

Name: LISA MAGARY
Title or Position: CO-OWNER
Credential: ARNP
Phone: 352-474-8686