PRIMARY CARE PHYSICIANS OF GAINESVILLE
Ambulatory Health at 83 St, Gainesville, FL

License number
Florida ARNP9391209
Category
Ambulatory Health
Type
Clinic/Center
Owner
Name: MRS. MELISSA BLAYLOCK
Title: OFFICE MANAGER
Phone: (352) 377-2022
Address
Address
3780 NW 83Rd St, Gainesville, FL 32606
National Provider ID: 1417498031
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

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PRIMARY CARE PHYSICIANS OF GAINESVILLE, PA

3780 NW 83 St, Gainesville, FL 32606

Status:
Inactive
Industry:
Family Practice & Pediatrics
Inactive reason:
NAME CHANGE AMENDMENT
Registration:
Aug 28, 1986
Inactive since:
Jun 14, 1996
State ID:
J30798
Business type:
Florida Profit Corporation
Presidents:
Elizabeth C Sanders (President, Secretary), 3780 NW 83, Gainesville, FL 32606 (Physical),Bette E. Boysen President, inactive
Agent:
Elizabeth Sanders,3780 NW 83 St, Gainesville, FL 32606 (Physical)
EIN:
59-2710945

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