Healthcare Provider Details

I. General information

NPI: 1245999853
Provider Name (Legal Business Name): NORTH FLORIDA FOOT & ANKLE SPECIALISTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2021
Last Update Date: 08/26/2024
Certification Date: 08/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

456 SE BAYA DRIVE
LAKE CITY FL
32025-6020
US

IV. Provider business mailing address

456 SE BAYA DRIVE
LAKE CITY FL
32025-6020
US

V. Phone/Fax

Practice location:
  • Phone: 352-525-2779
  • Fax: 352-525-2794
Mailing address:
  • Phone: 352-525-2779
  • Fax: 352-525-2794

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: JOSHUA ERIC EPSTEIN
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 770-880-9735