Healthcare Provider Details

I. General information

NPI: 1184116972
Provider Name (Legal Business Name): NORTH FLORIDA PEDIATRICS, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2018
Last Update Date: 10/22/2020
Certification Date: 10/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9770 OLD BAY MEADOWS ROAD, SUITE 101
JACKSONVILLE FL
32256-7986
US

IV. Provider business mailing address

9770 OLD BAY MEADOWS ROAD, SUITE 101
JACKSONVILLE FL
32256-7986
US

V. Phone/Fax

Practice location:
  • Phone: 386-758-0003
  • Fax: 386-755-7940
Mailing address:
  • Phone: 386-758-0003
  • Fax: 386-755-7940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SAMUEL SANTELICES
Title or Position: CEO
Credential: MD
Phone: 386-758-0003