ADVANCED PREVENTATIVE HEALTH (NPI# 1316439888) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1316439888 |
| Entity Type | Organization |
| Organization Name | ADVANCED PREVENTATIVE HEALTH |
| Practice Address |
163 Sw Stonegate Ter Ste 109 Lake City FL 32024-3459 |
| Mailing Address |
10348 Sw 32nd Ave Gainesville FL 32608-9096 |
| Practice Telephone | 3253173214 |
| Practice Fax Number | 3524361522 |
| Mailing Telephone | 3253173214 |
| Enumeration Date | 2018-05-31 |
| Last Update Date | 2018-05-31 |
| Authorized Official Name | MATTHEW S. ELLIS (OWNER) |
| Authorized Official Telephone | 3523173214 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207SG0201X |
Medical Genetics Specialization: Clinical Genetics (M.D.) |
Allopathic & Osteopathic Physicians | ||
| N | 207KA0200X |
Allergy & Immunology Specialization: Allergy |
Allopathic & Osteopathic Physicians | ||
| Y | 207QA0505X |
Family Medicine Specialization: Adult Medicine |
ME96520 | FL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | 2798866700 | 05 | |
| FL | MEDICAL LICENSE | ME96520 | 01 |
| Street Address |
163 SW STONEGATE TER STE 109 |
| City | LAKE CITY |
| State | FL |
| Zip Code | 32024-3459 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508181272 | Dynamic Health Centers | Family Medicine | 163 Sw Stonegate Ter Ste 109, Lake City, FL 32024-3459 | 2010-04-06 |
| 1417239914 | Catherine Rose Brown | Nurse Practitioner | 163 Sw Stonegate Ter Ste 109, Lake City, FL 32024-3459 | 2011-09-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083170534 | Sf Brevard, LLC | Skilled Nursing Facility | 298 Sw Prosperity Place, Lake City, FL 32024 | 2019-02-20 |
| 1689103079 | Vivian Robinson | Driver | 133 Sw Maereatha Ct, Lake City, FL 32024 | 2017-06-08 |
| 1508014630 | Stephen Lewis O'steen | Physical Therapy Assistant | 146 Sw Orthopaedic Court, Lake City, FL 32024 | 2008-09-03 |
| 1598965634 | Lake City Surgery Center, LLC | Clinic/Center | 208 Sw Prosperity Place, Lake City, FL 32024 | 2007-07-18 |
| 1932308145 | Smile Designs By Charlotte Gerry | Dentist | 857 Sw Main Blvd, Suite 105, Lake City, FL 32024 | 2007-07-17 |
| 1790900447 | Leopold Bejamin Leblique | General Practice | 264 Sw Ridgeview Pl., Lake City, FL 32024 | 2007-04-16 |
| 1073785911 | Rescare, Inc. | Intermediate Care Facility, Mentally Retarded | 1403 Spring St, Lake City, FL 32024 | 2008-04-01 |
| 1124202502 | Christina Mcghghy | Physical Therapy Assistant | 289 Sw Stonegate Terr, Suite #101, Lake City, FL 32024 | 2007-12-21 |
| 1629682133 | Paula Carol Palmer | Registered Nurse | 3857 Sw Birley Ave, Lake City, FL 32024-0003 | 2020-09-02 |
| 1831635176 | Patricia Vance | Chore Provider | 2238 Sw Salem Rd, Lake City, FL 32024-0029 | 2017-01-10 |
| Find all providers in zip 32024 | ||||
| Taxonomy Code | 207QA0505X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Specialization | Adult Medicine |
| Definition to come. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275842916 | Samuel Pryn Barker IIi | Family Medicine | 2806 W Us Highway 90, Suite 102, Lake City, FL 32055-4745 | 2010-09-29 |
| 1699138917 | Denise Driscoll | Family Medicine | 340 Nw Commerce Dr, Lake City, FL 32055-4709 | 2016-04-04 |
| 1174719629 | Raimah Primary Care Center Pa | Family Medicine | 1283 Sw State Road 47, 103, Lake City, FL 32025-0489 | 2007-09-19 |
| 1053486456 | Dawn Wilson | Family Medicine | 5499 Jonesboro Rd, Lake City, GA 30260-3553 | 2006-11-21 |
| 1588755029 | Ut Van Tran | Family Medicine | 619 S Marion Ave, Lake City, FL 32025 | 2006-09-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811598105 | Foundations Medical Center Pllc | Family Medicine | 4467 Commons Dr W Ste F-g, Destin, FL 32541-8454 | 2020-11-04 |
| 1831704345 | Vasundhara Kuchibhotla | Family Medicine | 1630 Sw 75th Ter, Gainesville, FL 32607-6604 | 2020-09-11 |
| 1356952170 | Discreet Health Solutions, LLC | Family Medicine | 7124 Pelican Island Dr, Tampa, FL 33634-7463 | 2020-08-14 |
| 1033728019 | Nana Aisha Garba | Family Medicine | 11200 Sw 8th St Ahc2 Rm 589b, Miami, FL 33199-0001 | 2020-07-27 |
| 1043838451 | Lisa M Parker | Family Medicine | 7955 Bay St Ste 2, Sebastian, FL 32958-3282 | 2020-07-13 |
| 1699390336 | Rosenie B Jasmin | Family Medicine | Dove Medical Centers, LLC, 2901 West Oakland Park Blvd Ste A4-5, Oakland Park, FL 33311 | 2020-06-09 |
| 1588287239 | Sarai L Gonzalez | Family Medicine | 16182 Nw 21st St, Pembroke Pines, FL 33028-1255 | 2020-05-28 |
| 1184247033 | Wellness Solutions 2020 LLC | Family Medicine | 2300 N Commerce Pkwy Ste 321, Weston, FL 33326-3257 | 2020-05-27 |
| 1780207910 | Homeville Medical Care | Family Medicine | 11040 Nw 18th Ct, Plantation, FL 33322-3407 | 2020-05-21 |
| 1942829536 | Health Medical Ultra Limited Liability Company | Family Medicine | 1760 Havendale Blvd Nw, Winter Haven, FL 33881-1224 | 2020-04-13 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.