=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598278707
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SUNBELT VISITING PRIMARY CARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/09/2017
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8833 PERIMETER PARK BLVD STE 901
-----------------------------------------------------
City | JACKSONVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32216-1113
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-240-4777
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2601 PAULORI DR
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32835-8143
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-553-2027
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FOUNDER/CDO
-----------------------------------------------------
Name | CHRISTOPHER LEE MERRITT
-----------------------------------------------------
Credential | BSN,RN,WCC
-----------------------------------------------------
Telephone | 904-553-2027
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------