# DYNAMIC HEALTH CENTERS

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1508181272
- **Authorized official:** MELISSA DISTEFANO (PRESIDENT)
- **Authorized official phone:** (352) 262-5625

## Contact information

- **Practice address:** 163 SW STONEGATE TER STE 109, LAKE CITY, FL 32024-3459
- **Practice address phone:** (386) 438-8391
- **Mailing address:** 163 SW STONEGATE TER STE 109, LAKE CITY, FL 32024-3459
- **Mailing address phone:** (386) 438-8391

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | HCC8936 | FL | — |
| 261QR1300X | Rural Health Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 04/06/2010
- **Last updated:** 07/29/2021