Provider Demographics
NPI:1801972138
Name:NORTH FLORIDA/ SOUTH GEORGIA VETERANS HEALTH SYSTEM
Entity type:Organization
Organization Name:NORTH FLORIDA/ SOUTH GEORGIA VETERANS HEALTH SYSTEM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ARNP
Authorized Official - Prefix:MRS
Authorized Official - First Name:FADRA
Authorized Official - Middle Name:S
Authorized Official - Last Name:MCINTOSH
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP,MSNGNP-BC
Authorized Official - Phone:352-376-1611
Mailing Address - Street 1:1601 SW ARCHER RD
Mailing Address - Street 2:GU 112C
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-1135
Mailing Address - Country:US
Mailing Address - Phone:352-316-1611
Mailing Address - Fax:352-374-6157
Practice Address - Street 1:1601 SW ARCHER RD
Practice Address - Street 2:GU 112C
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608-1135
Practice Address - Country:US
Practice Address - Phone:352-316-1611
Practice Address - Fax:352-374-6157
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2512952282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLVAD000Medicare UPIN