Healthcare Provider Details

I. General information

NPI: 1700362282
Provider Name (Legal Business Name): NORTH FLORIDA PEDIATRICS, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2018
Last Update Date: 07/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5686 US HIGHWAY 129 SOUTH SCHOOL CLINIC
JASPER FL
32052
US

IV. Provider business mailing address

1859 SW NEWLAND WAY
LAKE CITY FL
32256
US

V. Phone/Fax

Practice location:
  • Phone: 386-792-8000
  • Fax: 386-755-4432
Mailing address:
  • Phone: 386-758-0003
  • Fax: 386-755-4432

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

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