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General NPI Number Information
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NPI Number | 1629977715
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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 | 11/04/2026
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Last Update Date | 11/04/2026
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Provider Practice Location Address
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Address Line | 194 NE HANCOCK AVE
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City | MADISON
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State | FL
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Zip | 32340-2546
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Country | US
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Telephone | 850-253-2275
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Fax |
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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 | 32025-6966
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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 | CEO
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Name | SAMUEL SANTELICES
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Credential | MD
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Telephone | 352-281-2993
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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