Healthcare Provider Details

I. General information

NPI: 1295196236
Provider Name (Legal Business Name): PERSPECTIVES II
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2016
Last Update Date: 04/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9425 SE HIGHWAY 42
SUMMERFIELD FL
34491-6405
US

IV. Provider business mailing address

9425 SE HIGHWAY 42
SUMMERFIELD FL
34491-6405
US

V. Phone/Fax

Practice location:
  • Phone: 352-347-6272
  • Fax: 928-708-9620
Mailing address:
  • Phone: 352-347-6272
  • Fax: 928-708-9620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number0542AD770701
License Number StateFL

VIII. Authorized Official

Name: BETTY JO DONNELLY
Title or Position: CFO
Credential:
Phone: 352-347-6272