Provider Demographics
NPI:1992735682
Name:SUNSHINE MEDICAL OF NORTH FLORIDA, INC.
Entity type:Organization
Organization Name:SUNSHINE MEDICAL OF NORTH FLORIDA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MNGR
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:VANTASSELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-527-2287
Mailing Address - Street 1:3470 N LECANTO HWY
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:FL
Mailing Address - Zip Code:34465-3548
Mailing Address - Country:US
Mailing Address - Phone:352-527-2287
Mailing Address - Fax:352-746-2295
Practice Address - Street 1:3470 N LECANTO HWY
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:FL
Practice Address - Zip Code:34465-3548
Practice Address - Country:US
Practice Address - Phone:352-527-2287
Practice Address - Fax:352-746-2295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0048978207R00000X
FLPT5465208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Not Answered208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK3726Medicare ID - Type Unspecified