Provider Demographics
NPI:1629713326
Name:SKYLIGHT HEALTH OF FLORIDA CLINICS PA
Entity Type:Organization
Organization Name:SKYLIGHT HEALTH OF FLORIDA CLINICS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:FAROOQ
Authorized Official - Middle Name:
Authorized Official - Last Name:AKHTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:855-874-4999
Mailing Address - Street 1:5520 EXPLORER DRIVE
Mailing Address - Street 2:SUITE 402
Mailing Address - City:MISSISSAUGA
Mailing Address - State:ONTARIO
Mailing Address - Zip Code:L4W5L1
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:630 JACKSONVILLE DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-3814
Practice Address - Country:US
Practice Address - Phone:844-644-8880
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-28
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty