Healthcare Provider Details

I. General information

NPI: 1619287158
Provider Name (Legal Business Name): IPN EMERGENCY PHYSICIANS OF NORTH FLORIDA PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2010
Last Update Date: 10/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

922 E CALL ST
STARKE FL
32091-3616
US

IV. Provider business mailing address

14050 NW 14TH ST SUITE 190
SUNRISE FL
33323-2865
US

V. Phone/Fax

Practice location:
  • Phone: 904-368-2324
  • Fax:
Mailing address:
  • Phone: 800-424-3672
  • Fax: 954-377-3042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. STEPHEN G. HOLTZCLAW
Title or Position: PRESIDENT
Credential: MD
Phone: 800-424-3672