Healthcare Provider Details

I. General information

NPI: 1033971064
Provider Name (Legal Business Name): B-LEEVE PRIMARY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2024
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1734 KINGSLEY AVE STE 7
ORANGE PARK FL
32073-4418
US

IV. Provider business mailing address

6295 SANDS POINTE DR
MACCLENNY FL
32063-6045
US

V. Phone/Fax

Practice location:
  • Phone: 904-474-9766
  • Fax: 866-531-4642
Mailing address:
  • Phone: 904-474-9766
  • Fax: 904-513-9271

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: QUAWENDELLA BAEJUHNE SKINNER
Title or Position: PRESIDENT
Credential:
Phone: 904-676-6062