# NORTH FLORIDA PEDIATRICS PA

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** NORTH FLORIDA PEDIATRICS PA
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1548758428
- **Legal business name:** NORTH FLORIDA PEDIATRICS PA
- **Authorized official:** SAMUEL SANTELICES (PRESIDENT/CEO)
- **Authorized official phone:** (386) 758-0003

## Contact information

- **Practice address:** 417 EAST CALL STREET, STARKE, FL 32091
- **Practice address phone:** (904) 368-0368
- **Practice address fax:** (904) 317-4949
- **Mailing address:** 1859 S.W. NEWLAND WAY, LAKE CITY, FL 32025
- **Mailing address phone:** (386) 758-0003
- **Mailing address fax:** (386) 755-4432

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208000000X | Pediatrics Physician | — | NULL | — |
| 208000000X | Pediatrics Physician | — | — | — |
| 261QR1300X | Rural Health Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 04/26/2018
- **Last updated:** 09/08/2021