Healthcare Provider Details

I. General information

NPI: 1760315014
Provider Name (Legal Business Name): CITRUS MEMORIAL HOSPITAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2026
Last Update Date: 06/05/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3470 W NORVELL BRYANT HWY
LECANTO FL
34461
US

IV. Provider business mailing address

3470 W NORVELL BRYANT HWY
LECANTO FL
34461
US

V. Phone/Fax

Practice location:
  • Phone: 352-513-6444
  • Fax:
Mailing address:
  • Phone: 352-513-6444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0002X
TaxonomyEmergency Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JODAN FULKERSON
Title or Position: CFO
Credential:
Phone: 727-341-4806