Healthcare Provider Details

I. General information

NPI: 1821641150
Provider Name (Legal Business Name): NORTH FLORIDA NATURAL HEALTH, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2019
Last Update Date: 07/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 11TH STREET SW SUITE 206
LIVE OAK FL
32064
US

IV. Provider business mailing address

10848 169TH ROAD
LIVE OAK FL
32060
US

V. Phone/Fax

Practice location:
  • Phone: 386-209-0771
  • Fax: 386-703-2187
Mailing address:
  • Phone: 386-249-5319
  • Fax: 386-703-2187

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. SARAH MARCIA STETSON
Title or Position: LICENSED MASSAGE THERAPIST
Credential: LMT
Phone: 386-249-5319