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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 MD (PRESIDENT/ CEO)
(386) 758-0003
Entity
Organization
Contact information
Practice address
NORTH FLORIDA PEDIATRICS, PA, 1101 OHIO AVENUE SOUTH, LIVE OAK, FL 32064
(386) 339-1060
(386) 339-1067
Mailing address
1859 SW NEWLAND WAY, LAKE CITY, FL 32025-6966
(386) 758-0003
(386) 755-4432
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
—
NULL
208000000X
Pediatrics Physician
—
—
2080A0000X
Pediatric Adolescent Medicine Physician
—
NULL
2080A0000X
Pediatric Adolescent Medicine Physician
—
—
261QR1300X
Rural Health Clinic/Center
Primary
—
NULL
Other
Enumeration date
03/01/2013
Last updated
09/08/2021
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