Healthcare Provider Details

I. General information

NPI: 1265192926
Provider Name (Legal Business Name): ORMOND FAMILY MEDICAL CENTER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2021
Last Update Date: 10/01/2024
Certification Date: 10/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

545 W GRANADA BLVD
ORMOND BEACH FL
32174-5103
US

IV. Provider business mailing address

545 W GRANADA BLVD
ORMOND BEACH FL
32174-5103
US

V. Phone/Fax

Practice location:
  • Phone: 386-672-6243
  • Fax: 386-677-7463
Mailing address:
  • Phone: 386-672-6243
  • Fax: 386-677-7463

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: STEPHANIE SANCHEZ
Title or Position: OWNER
Credential: APRN, FNP-BC
Phone: 407-415-3871