Provider Demographics
NPI:1891037495
Name:SOUTHEASTERN INTEGREATED MEDICAL P.L.
Entity Type:Organization
Organization Name:SOUTHEASTERN INTEGREATED MEDICAL P.L.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIVISION MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:A
Authorized Official - Last Name:PREVATT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-224-2370
Mailing Address - Street 1:3700 WINDMEADOWS BLVD
Mailing Address - Street 2:APT 77
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608
Mailing Address - Country:US
Mailing Address - Phone:352-275-6562
Mailing Address - Fax:
Practice Address - Street 1:1315 N W 21ST AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:CHIEFLAND
Practice Address - State:FL
Practice Address - Zip Code:32626
Practice Address - Country:US
Practice Address - Phone:352-493-1741
Practice Address - Fax:352-490-8641
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-21
Last Update Date:2013-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9299250363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty