Organization
WILLISTON PEDIATRICS, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. ANDREA M QUINLAN (TREASURER)
(352) 529-0477
Entity
Organization
Contact information
Practice address
223 N MAIN ST, WILLISTON, FL 32696-2136
(352) 529-0477
(352) 529-0406
Mailing address
223 N MAIN ST, WILLISTON, FL 32696-2136
(352) 529-0477
(352) 529-0406
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
—
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
660141300
—
FL
05
—
660141301
—
FL
Enumeration date
10/12/2006
Last updated
10/28/2020
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