Organization
NORTH FLORIDA REGIONAL PSYCHIATRY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RAVEN SHENETTE MAYES ONA (OPTOMETRIST)
(352) 792-8069
Entity
Organization
Contact information
Practice address
1121 NW 64TH TER STE B, GAINESVILLE, FL 32605-4256
(615) 372-5426
Mailing address
2101 NE 2ND ST APT 114, GAINESVILLE, FL 32609-8626
(352) 792-8069
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
50-2560
FLORIDA ISSUE PROVIDER
FL
Enumeration date
03/25/2019
Last updated
03/16/2021
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