# FLORIDA STATE UNIVERSITY

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- **Entity:** Organization
- **Status:** Active
- **Other names:** FSU Healthy Lifestyle Medicine Clinic
- **Organization subpart:** No

## Provider details

- **NPI number:** 1902003536
- **Authorized official:** JEAN WANG (DEAN COLLEGE OF NURSING)
- **Authorized official phone:** (850) 644-5707

## Contact information

- **Practice address:** 1630 RIGGINS RD, TALLAHASSEE, FL 32308-5316
- **Practice address phone:** (850) 878-4434
- **Practice address fax:** (850) 878-4423
- **Mailing address:** 1630 RIGGINS RD, TALLAHASSEE, FL 32308-5316
- **Mailing address phone:** (850) 878-4434
- **Mailing address fax:** (850) 878-4423

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LP2300X | Primary Care Nurse Practitioner | — | NULL | Yes |
| 363LP2300X | Primary Care Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 06/28/2007
- **Last updated:** 02/24/2025