MEDICARE: SUNSHINE MEDICAL OF NORTH FLORIDA, INC.

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	207R00000X	Internal Medicine Physician	ME0048978	FL
2	208100000X	Physical Medicine & Rehabilitation Physician	PT5465	FL

General Provider Information

NPI Number	:	1992735682
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUNSHINE MEDICAL OF NORTH FLORIDA, INC.

Provider Business Mailing Address
First Line	:	3470 N LECANTO HWY
Second Line	:
City	:	BEVERLY HILLS
State	:	FL
Zip	:	34465-3548
Country	:	US
Telephone Number	:	352-527-2287
Fax Number	:	352-746-2295

Provider Business Practice Location Address
First Line	:	3470 N LECANTO HWY
Second Line	:
City	:	BEVERLY HILLS
State	:	FL
Zip	:	34465-3548
Country	:	US
Telephone Number	:	352-527-2287
Fax Number	:	352-746-2295

Authorized Official
Title or Position	:	OFFICE MNGR
Name	:	TAMMY VANTASSELL
Credential	:
Telephone Number	:	352-527-2287

Provider Enumeration Date	:	07/05/2006
Last Update Date	:	09/11/2025

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