| Organization Name: | SOUTHEASTERN INTEGREATED MEDICAL P.L. |
| NPI Number: | 1891037495 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | CINDY A PREVATT (DIVISION MANAGER) |
| Mailing Address: | 1315 N W 21st Ave Suite 2 Chiefland |
| State: | FL US |
| Postal Code: | 32626 |
| Phone Number: | 3524931741 |
| Fax Number: | 3524908641 |
| NPI Enumeration Date: | 03/21/2013 |
| NPI Last Update Date: | 03/21/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | ARNP9299250 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |