Healthcare Provider Details

I. General information

NPI: 1477568186
Provider Name (Legal Business Name): RIVERSIDE FAMILY HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 10/04/2026
Certification Date: 10/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1395 N COURTENAY PKWY STE 100
MERRITT ISLAND FL
32953-4474
US

IV. Provider business mailing address

1395 N COURTENAY PKWY STE 100
MERRITT ISLAND FL
32953-4474
US

V. Phone/Fax

Practice location:
  • Phone: 321-453-5252
  • Fax: 321-453-5152
Mailing address:
  • Phone: 321-453-5252
  • Fax: 321-453-5152

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: KIMBERLY NAOUMOFF
Title or Position: PRACTICE MANAGER
Credential:
Phone: 321-453-5252