Provider Demographics
NPI:1710449509
Name:NORTH FLORIDA NATURAL HEALTH, INC.
Entity Type:Organization
Organization Name:NORTH FLORIDA NATURAL HEALTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:MARCIA
Authorized Official - Last Name:STETSON
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:386-249-5319
Mailing Address - Street 1:10848 169TH RD
Mailing Address - Street 2:
Mailing Address - City:LIVE OAK
Mailing Address - State:FL
Mailing Address - Zip Code:32060-6248
Mailing Address - Country:US
Mailing Address - Phone:386-249-5319
Mailing Address - Fax:
Practice Address - Street 1:405 11TH ST SW STE 206
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:FL
Practice Address - Zip Code:32064-3162
Practice Address - Country:US
Practice Address - Phone:386-249-5319
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-02
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service