Healthcare Provider Details

I. General information

NPI: 1467351551
Provider Name (Legal Business Name): NORTH FLORIDA PEDIATRICS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2026
Last Update Date: 11/04/2026
Certification Date: 11/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1702 S JEFFERSON ST
PERRY FL
32348-5611
US

IV. Provider business mailing address

1859 SW NEWLAND WAY
LAKE CITY FL
32025-6966
US

V. Phone/Fax

Practice location:
  • Phone: 855-577-5437
  • Fax:
Mailing address:
  • Phone: 386-758-0003
  • Fax: 386-755-4432

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: SAMUEL SANTELICES
Title or Position: CEO
Credential: MD
Phone: 352-281-2993