Healthcare Provider Details

I. General information

NPI: 1578991212
Provider Name (Legal Business Name): NORTH FLORIDA PERINATAL ASSOCIATES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2013
Last Update Date: 07/08/2021
Certification Date: 07/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2202 STATE AVE SUITE 103
PANAMA CITY FL
32405-4590
US

IV. Provider business mailing address

PO BOX 452016
SUNRISE FL
33345-2016
US

V. Phone/Fax

Practice location:
  • Phone: 855-249-6872
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: KATHLEEN KONDAS
Title or Position: OFFICER
Credential:
Phone: 877-328-1119