# NORTH FLORIDA PEDIATRICS, PA.

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** NORTH FLORIDA PEDIATRICS, P.A
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1376548602
- **Legal business name:** NORTH FLORIDA PEDIATRICS, P.A
- **Authorized official:** SAMUEL SANTELICES MD. (PRESIDENT/ CEO)
- **Authorized official phone:** (386) 758-0003

## Contact information

- **Practice address:** NORTH FLORIDA PEDIATRICS PA ., 1859 SW NEWLAND WAY, LAKE CITY, FL 32025
- **Practice address phone:** (386) 758-0003
- **Practice address fax:** (386) 755-4432
- **Mailing address:** 1859 SW NEWLAND WAY, LAKE CITY, FL 32025-6966
- **Mailing address phone:** (386) 758-0003
- **Mailing address fax:** (386) 755-4432

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208000000X | Pediatrics Physician | ME87551 | FL | — |
| 2080A0000X | Pediatric Adolescent Medicine Physician | ME87551 | FL | — |
| 261QR1300X | Rural Health Clinic/Center | ME87551 | FL | Yes |

## Other

- **Enumeration date:** 06/14/2005
- **Last updated:** 09/08/2021