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Organization
NORTHEAST FLORIDA HEALTH SERVICES, INC.
Active
Organization
NORTHEAST FLORIDA HEALTH SERVICES, INC.
Active
Parent organization
NORTHEAST FLORIDA HEALTH SERVICES, INC.
Other names
FAMILY HEALTH SOURCE
Organization subpart
Yes
Provider details
NPI number
Legal business name
NORTHEAST FLORIDA HEALTH SERVICES, INC.
Authorized official
REBECCA COLLIER (CREDENTIALING/CONTRACTS ADMIN.)
(386) 202-6025
Entity
Organization
Contact information
Practice address
1200 DELTONA BLVD, DELTONA, FL 32725-6306
(386) 327-6060
(386) 223-1799
Mailing address
1205 S WOODLAND BLVD STE 3, DELAND, FL 32720-7464
(386) 202-6025
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
687955120
—
FL
Enumeration date
08/27/2021
Last updated
08/27/2021
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