Healthcare Provider Details

I. General information

NPI: 1366848087
Provider Name (Legal Business Name): DEPARTMENT OF VETRANS AFFAIRS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2014
Last Update Date: 11/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 SW ARCHER RD
GAINESVILLE FL
32608-1135
US

IV. Provider business mailing address

15164 NW 150TH AVE APT.3057
ALACHUA FL
32615-5540
US

V. Phone/Fax

Practice location:
  • Phone: 352-548-6000
  • Fax:
Mailing address:
  • Phone: 386-518-5290
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number229833
License Number StateFL

VIII. Authorized Official

Name: MS. NATASHA NELSON
Title or Position: CERTIFIED NURSE
Credential:
Phone: 386-518-5290