Healthcare Provider Details

I. General information

NPI: 1477808046
Provider Name (Legal Business Name): ADVENTIST HEALTH SYSTEM SUNBELT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2012
Last Update Date: 11/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15502 STONEYBROOK WEST PKWY SUITE 2-108
WINTER GARDEN FL
34787-4767
US

IV. Provider business mailing address

15502 STONEYBROOK WEST PKWY SUITE 2-108
WINTER GARDEN FL
34787-4767
US

V. Phone/Fax

Practice location:
  • Phone: 407-656-0042
  • Fax: 407-656-0633
Mailing address:
  • Phone: 407-656-0042
  • Fax: 407-656-0633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. DARYL TOL
Title or Position: PRESIDENT/CEO
Credential:
Phone: 407-303-1531