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General NPI Number Information
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NPI Number | 1407042807
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Entity Type | Organization
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Legal Business Name | ALACHUA INTEGRATIVE MEDICINE, INC
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Dates
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Enumeration Date | 09/19/2007
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Last Update Date | 09/27/2007
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Provider Practice Location Address
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Address Line | 14804 NW 140TH ST
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City | ALACHUA
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State | FL
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Zip | 32615-6276
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Country | US
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Telephone | 386-418-1234
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Fax | 386-418-8203
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Provider Business Mailing Address
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Address Line | 14804 NW 140TH ST
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City | ALACHUA
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State | FL
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Zip | 32615-6276
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Country | US
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Telephone | 386-418-1234
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Fax | 386-418-8203
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | PATRICIA CONCEICAO
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Credential |
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Telephone | 386-418-1234
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 1557262
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License Number State | FL
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