Healthcare Provider Details

I. General information

NPI: 1215535794
Provider Name (Legal Business Name): STANKUS FAMILY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2020
Last Update Date: 06/03/2022
Certification Date: 06/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18743 NW 234TH ST
HIGH SPRINGS FL
32643-0465
US

IV. Provider business mailing address

18743 NW 234TH ST
HIGH SPRINGS FL
32643-0465
US

V. Phone/Fax

Practice location:
  • Phone: 352-214-5807
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH STANKUS
Title or Position: OWNER
Credential: APRN
Phone: 352-214-5807