Healthcare Provider Details

I. General information

NPI: 1609648971
Provider Name (Legal Business Name): OUR FAMILY HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2023
Last Update Date: 10/30/2023
Certification Date: 10/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10752 DEERWOOD PARK BLVD STE 100
JACKSONVILLE FL
32256-4846
US

IV. Provider business mailing address

10752 DEERWOOD PARK BLVD STE 100
JACKSONVILLE FL
32256-4846
US

V. Phone/Fax

Practice location:
  • Phone: 407-953-9734
  • Fax:
Mailing address:
  • Phone: 407-953-9734
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. DAVID BAKER-HARGROVE
Title or Position: CICO/CO-CEO
Credential: PH.D.
Phone: 407-953-9734