Provider Demographics
NPI:1942699509
Name:NATURE COAST FAMILY MEDICINE
Entity type:Organization
Organization Name:NATURE COAST FAMILY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHUKWUMA
Authorized Official - Middle Name:MBONU
Authorized Official - Last Name:OKOROJI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-591-1962
Mailing Address - Street 1:2473 CARE DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-9814
Mailing Address - Country:US
Mailing Address - Phone:850-591-1962
Mailing Address - Fax:
Practice Address - Street 1:2473 CARE DR
Practice Address - Street 2:SUITE 102
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-9814
Practice Address - Country:US
Practice Address - Phone:850-591-1962
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NATURE COAST WOMEN'S CARE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-01-20
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME103799261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001320500Medicaid