Healthcare Provider Details

I. General information

NPI: 1003451816
Provider Name (Legal Business Name): FACULTY ASSOCIATES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2019
Last Update Date: 11/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

76011 WILLIAM BURGESS BOULEVARD
YULEE FL
32097
US

IV. Provider business mailing address

76011 WILLIAM BURGESS BOULEVARD
YULEE FL
32097
US

V. Phone/Fax

Practice location:
  • Phone: 352-273-5801
  • Fax: 352-392-3070
Mailing address:
  • Phone: 352-273-5801
  • Fax: 352-392-3070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: JEAN M SWEITZER
Title or Position: SECRETARY/TREASURER
Credential:
Phone: 352-273-5787