Provider Demographics
NPI:1013369719
Name:ACUPUNCTURE CENTER OF NORTH FLORIDA, LLC
Entity Type:Organization
Organization Name:ACUPUNCTURE CENTER OF NORTH FLORIDA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAZIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALI HAMM
Authorized Official - Suffix:
Authorized Official - Credentials:AP
Authorized Official - Phone:352-727-8812
Mailing Address - Street 1:5200 NW 43RD ST
Mailing Address - Street 2:STE 102 PMB 336
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32606-4484
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7328 W UNIVERSITY AVE
Practice Address - Street 2:STE F
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32607-1695
Practice Address - Country:US
Practice Address - Phone:352-727-9153
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-06
Last Update Date:2016-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP2500171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1437370459OtherNPPES - INDIVIDUAL NPI
1619198637OtherNPPES - INDIVIDUAL NPI