Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Dynamic Primary Healthcare Clinic

Organization Family Medicine Physician · NPI 1710633144

Dynamic Primary Healthcare Clinic is a Family Medicine Physician in Lake City, Florida. Registered with an NPI since 2022.

In the registry since
2022

Practice location Address checks out

163 SW Stonegate Ter Ste 109
Lake City, FL 32024-3459
Phone: (330) 323-8976
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X

Record details

NPI number1710633144
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official John Distefano — Business Manager · (352) 317-3214
NPI enumeratedFebruary 24, 2022
Last updated in NPPESMarch 18, 2024
Certification dateMarch 18, 2024
Mailing address924 Se Lantana Loop, Lake City, FL 32025-6848

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