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General NPI Number Information
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NPI Number | 1942516935
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Entity Type | Organization
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Legal Business Name | NORTH FLORIDA MEDICAL GROUP
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Dates
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Enumeration Date | 08/27/2010
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Last Update Date | 08/27/2010
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Provider Practice Location Address
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Address Line | 1702 OHIO AVE
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City | LYNN HAVEN
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State | FL
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Zip | 32444-4290
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Country | US
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Telephone | 850-747-2010
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Fax | 850-747-2016
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Provider Business Mailing Address
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Address Line | 1702 OHIO AVE
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City | LYNN HAVEN
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State | FL
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Zip | 32444-4290
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Country | US
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Telephone | 850-747-2010
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Fax | 850-747-2016
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. KIM D SHINSKY
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Credential |
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Telephone | 850-867-2006
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | ME97726
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | ME95473
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | ARNP2800032
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | ME103213
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License Number State | FL
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