Provider Demographics
NPI:1700362282
Name:NORTH FLORIDA PEDIATRICS, PA
Entity Type:Organization
Organization Name:NORTH FLORIDA PEDIATRICS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTELICES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:386-758-0003
Mailing Address - Street 1:1859 SW NEWLAND WAY
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32256
Mailing Address - Country:US
Mailing Address - Phone:386-758-0003
Mailing Address - Fax:386-755-4432
Practice Address - Street 1:5686 US HIGHWAY 129 SOUTH
Practice Address - Street 2:SCHOOL CLINIC
Practice Address - City:JASPER
Practice Address - State:FL
Practice Address - Zip Code:32052
Practice Address - Country:US
Practice Address - Phone:386-792-8000
Practice Address - Fax:386-755-4432
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-17
Last Update Date:2018-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty