MEDICARE: SOUTHSIDE FAMILY PRACTICE &WOMENS HEALTH PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	ME83942	FL

General Provider Information

NPI Number	:	1326171190
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHSIDE FAMILY PRACTICE &WOMENS HEALTH PA

Provider Business Mailing Address
First Line	:	8075 GATE PKWY W
Second Line	:	SUITE 102&103
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-3684
Country	:	US
Telephone Number	:	904-296-1010
Fax Number	:	904-296-0393

Provider Business Practice Location Address
First Line	:	8075 GATE PKWY W
Second Line	:	SUITE 102&103
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-3684
Country	:	US
Telephone Number	:	904-296-1010
Fax Number	:	904-296-0393

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. SUPARNA GULANI
Credential	:	M.D
Telephone Number	:	904-296-1010

Provider Enumeration Date	:	03/13/2007
Last Update Date	:	12/04/2012

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Directions to “SOUTHSIDE FAMILY PRACTICE &WOMENS HEALTH PA ” Practice Location

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