Healthcare Provider Details

I. General information

NPI: 1548121270
Provider Name (Legal Business Name): SUMMER FLACK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2025
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 BLANDING BLVD STE 1
ORANGE PARK FL
32073-2624
US

IV. Provider business mailing address

155 BLANDING BLVD
ORANGE PARK FL
32073-2630
US

V. Phone/Fax

Practice location:
  • Phone: 877-823-4283
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-506918
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: