=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992735682
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SUNSHINE MEDICAL OF NORTH FLORIDA, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/05/2006
-----------------------------------------------------
Last Update Date | 09/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3470 N LECANTO HWY
-----------------------------------------------------
City | BEVERLY HILLS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34465-3548
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-527-2287
-----------------------------------------------------
Fax | 352-746-2295
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3470 N LECANTO HWY
-----------------------------------------------------
City | BEVERLY HILLS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34465-3548
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-527-2287
-----------------------------------------------------
Fax | 352-746-2295
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MNGR
-----------------------------------------------------
Name | TAMMY VANTASSELL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 352-527-2287
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | ME0048978
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 208100000X
-----------------------------------------------------
Taxonomy Name | Physical Medicine & Rehabilitation Physician
-----------------------------------------------------
License Number | PT5465
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------