Healthcare Provider Details

I. General information

NPI: 1780777391
Provider Name (Legal Business Name): ADVENTIST HEALTH SYSTEM SUNBELT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 05/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 BENMORE DR. SUITE 200
WINTER PARK FL
32792-4143
US

IV. Provider business mailing address

133 BENMORE DR. SUITE 200
WINTER PARK FL
32792-4143
US

V. Phone/Fax

Practice location:
  • Phone: 407-646-7070
  • Fax: 407-646-7747
Mailing address:
  • Phone: 407-646-7070
  • Fax: 407-646-7747

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

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