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General NPI Number Information
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NPI Number | 1598435190
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Entity Type | Organization
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Legal Business Name | NORTH FLORIDA PEDIATRICS, PA.
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Dates
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Enumeration Date | 09/15/2021
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Last Update Date | 09/15/2021
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Provider Practice Location Address
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Address Line | NORTH FLORIDA PEDIATRICS, PA. 1117 NW HWY 41 STE B
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City | JASPER
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State | FL
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Zip | 32052
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Country | US
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Telephone | 386-792-3864
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Fax | 386-792-1530
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Provider Business Mailing Address
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Address Line | 1859 SW NEWLAND WAY
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City | LAKE CITY
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State | FL
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Zip | 32025
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Country | US
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Telephone | 386-758-0003
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Fax | 386-755-4432
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Authorized Official
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Title or Position | PRESIDENT / CEO
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Name | SAMUEL SANTELICES
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Credential | MD.
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Telephone | 386-758-0003
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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