Healthcare Provider Details

I. General information

NPI: 1255151429
Provider Name (Legal Business Name): XTRA HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2024
Last Update Date: 10/14/2024
Certification Date: 10/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12036 NW 1ST LN STE 200
GAINESVILLE FL
32607-1123
US

IV. Provider business mailing address

12036 NW 1ST LN STE 200
GAINESVILLE FL
32607-1123
US

V. Phone/Fax

Practice location:
  • Phone: 904-347-1700
  • Fax:
Mailing address:
  • Phone: 904-347-1700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number
License Number State

VIII. Authorized Official

Name: MR. JAMES P MAHER III
Title or Position: CEO
Credential:
Phone: 904-347-1700