Provider Demographics
NPI:1184116972
Name:NORTH FLORIDA PEDIATRICS, PA
Entity type:Organization
Organization Name:NORTH FLORIDA PEDIATRICS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position: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 1:9770 OLD BAY MEADOWS ROAD, SUITE 101
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-7986
Mailing Address - Country:US
Mailing Address - Phone:386-758-0003
Mailing Address - Fax:386-755-7940
Practice Address - Street 1:9770 OLD BAY MEADOWS ROAD, SUITE 101
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-7986
Practice Address - Country:US
Practice Address - Phone:386-758-0003
Practice Address - Fax:386-755-7940
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTH FLORIDA PEDIATRICS, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-06-06
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty