Provider Demographics
NPI:1952145690
Name:CITRA FAMILY HEALTH
Entity type:Organization
Organization Name:CITRA FAMILY HEALTH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAFFAGNINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-300-7505
Mailing Address - Street 1:17805 N US HIGHWAY 301
Mailing Address - Street 2:
Mailing Address - City:CITRA
Mailing Address - State:FL
Mailing Address - Zip Code:32113-2459
Mailing Address - Country:US
Mailing Address - Phone:352-595-1718
Mailing Address - Fax:
Practice Address - Street 1:17805 N US HIGHWAY 301
Practice Address - Street 2:
Practice Address - City:CITRA
Practice Address - State:FL
Practice Address - Zip Code:32113-2459
Practice Address - Country:US
Practice Address - Phone:352-595-1718
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-19
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center