Organization
SUWANNEE COUNTY SCHOOL BOARD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TYLYN STANSEL (MEDICAID CONTACT)
(386) 647-4632
Entity
Organization
Contact information
Practice address
1740 OHIO AVE S, LIVE OAK, FL 32064-4500
(386) 647-4632
Mailing address
1740 OHIO AVE S, LIVE OAK, FL 32064-4500
(386) 647-4632
Taxonomy
Speciality
Code
Description
License number
State
251300000X
Local Education Agency (LEA)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008046218
—
FL
Enumeration date
12/29/2006
Last updated
02/02/2026
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