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NPI Code Detail

MEDICARE: NORTH FLORIDA MEDICAL GROUP

MEDICARE: NORTH FLORIDA MEDICAL GROUP
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
1208200000XPlastic Surgery PhysicianME97726FL
2208600000XSurgery PhysicianME95473FL
3363L00000XNurse PractitionerARNP2800032FL
4208D00000XGeneral Practice PhysicianME103213FL

General Provider Information

NPI Number : 1942516935
Entity Type Code : Organization
Provider Name (Legal Business Name) : NORTH FLORIDA MEDICAL GROUP
Provider Business Mailing Address
First Line : 1702 OHIO AVE
Second Line :
City : LYNN HAVEN
State : FL
Zip : 32444-4290
Country : US
Telephone Number : 850-747-2010
Fax Number : 850-747-2016
Provider Business Practice Location Address
First Line : 1702 OHIO AVE
Second Line :
City : LYNN HAVEN
State : FL
Zip : 32444-4290
Country : US
Telephone Number : 850-747-2010
Fax Number : 850-747-2016
Authorized Official
Title or Position : ADMINISTRATOR
Name : MRS. KIM D SHINSKY
Credential :
Telephone Number : 850-867-2006
Provider Enumeration Date : 08/27/2010
Last Update Date : 08/27/2010

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Directions to “NORTH FLORIDA MEDICAL GROUP ” Practice Location

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