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General NPI Number Information
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NPI Number | 1891037495
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Entity Type | Organization
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Legal Business Name | SOUTHEASTERN INTEGREATED MEDICAL P.L.
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Dates
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Enumeration Date | 03/21/2013
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Last Update Date | 03/21/2013
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Provider Practice Location Address
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Address Line | 1315 N W 21ST AVE SUITE 2
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City | CHIEFLAND
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State | FL
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Zip | 32626
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Country | US
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Telephone | 352-493-1741
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Fax | 352-490-8641
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Provider Business Mailing Address
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Address Line | 3700 WINDMEADOWS BLVD APT 77
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City | GAINESVILLE
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State | FL
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Zip | 32608
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Country | US
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Telephone | 352-275-6562
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Fax |
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Authorized Official
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Title or Position | DIVISION MANAGER
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Name | MS. CINDY A PREVATT
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Credential |
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Telephone | 352-224-2370
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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 | ARNP9299250
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License Number State | FL
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