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General NPI Number Information
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NPI Number | 1154503902
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Entity Type | Organization
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Legal Business Name | HOLISTIC FAMILY HEALTH CLINIC, P.A.
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Dates
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Enumeration Date | 12/04/2007
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Last Update Date | 12/04/2007
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Provider Practice Location Address
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Address Line | 3620 S HOPKINS AVE SUITE 101
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City | TITUSVILLE
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State | FL
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Zip | 32780-5707
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Country | US
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Telephone | 321-385-1000
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 259
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City | SCOTTSMOOR
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State | FL
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Zip | 32775-0259
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Country | US
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Telephone | 321-385-1000
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | DEBORAH LEE
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Credential | DOM, AP, CHT
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Telephone | 321-385-1000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | AP1651
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License Number State | FL
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