Organization
DYNAMIC HEALTH CENTERS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MELISSA DISTEFANO (PRESIDENT)
(352) 262-5625
Entity
Organization
Contact information
Practice address
163 SW STONEGATE TER STE 109, LAKE CITY, FL 32024-3459
(386) 438-8391
Mailing address
163 SW STONEGATE TER STE 109, LAKE CITY, FL 32024-3459
(386) 438-8391
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
HCC8936
FL
261QR1300X
Rural Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
006309100
—
FL
Enumeration date
04/06/2010
Last updated
07/29/2021
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