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Organization
NORTH FLORIDA PEDIATRICS PA
Active
Organization
NORTH FLORIDA PEDIATRICS PA
Active
Parent organization
NORTH FLORIDA PEDIATRICS PA
Organization subpart
Yes
Provider details
NPI number
Legal business name
NORTH FLORIDA PEDIATRICS PA
Authorized official
SAMUEL SANTELICES (PRESIDENT/CEO)
(386) 758-0003
Entity
Organization
Contact information
Practice address
417 EAST CALL STREET, STARKE, FL 32091
(904) 368-0368
(904) 317-4949
Mailing address
1859 S.W. NEWLAND WAY, LAKE CITY, FL 32025
(386) 758-0003
(386) 755-4432
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
—
NULL
208000000X
Pediatrics Physician
—
—
261QR1300X
Rural Health Clinic/Center
Primary
—
NULL
Other
Enumeration date
04/26/2018
Last updated
09/08/2021
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