Provider Demographics
NPI:1952060980
Name:MAGNOLIA FAMILY CARE CORP.
Entity Type:Organization
Organization Name:MAGNOLIA FAMILY CARE CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:LYN
Authorized Official - Last Name:BRYAN
Authorized Official - Suffix:
Authorized Official - Credentials:APRN-C
Authorized Official - Phone:386-755-3300
Mailing Address - Street 1:777 WEST DUVAL STREET
Mailing Address - Street 2:OPTIONAL
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32055
Mailing Address - Country:US
Mailing Address - Phone:386-755-3300
Mailing Address - Fax:386-755-8595
Practice Address - Street 1:777 WEST DUVAL STREET
Practice Address - Street 2:OPTIONAL
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32055
Practice Address - Country:US
Practice Address - Phone:386-755-3300
Practice Address - Fax:386-755-8595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-17
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care