MEDICARE: PARTHENON MEDICAL PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	103TA0400X	Addiction (Substance Use Disorder) Psychologist
2	207LA0401X	Addiction Medicine (Anesthesiology) Physician
3	207QA0401X	Addiction Medicine (Family Medicine) Physician
4	207R00000X	Internal Medicine Physician
5	208000000X	Pediatrics Physician
6	2083A0300X	Addiction Medicine (Preventive Medicine) Physician
7	261QU0200X	Urgent Care Clinic/Center
8	363LP0200X	Pediatric Nurse Practitioner
9	363LP2300X	Primary Care Nurse Practitioner

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285117549
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PARTHENON MEDICAL PLLC

Provider Business Mailing Address
First Line	:	5105 BOWDEN RD STE 3
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-5907
Country	:	US
Telephone Number	:	904-609-3349
Fax Number	:	904-212-2227

Provider Business Practice Location Address
First Line	:	5105 BOWDEN RD STE 3
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-5907
Country	:	US
Telephone Number	:	904-660-7896
Fax Number	:	904-212-2227

Authorized Official
Title or Position	:	NURSE PRACTITIONER
Name	:	MR. PHILIP CARNEVALE
Credential	:	APRN, FNP-C
Telephone Number	:	904-609-3349

Provider Enumeration Date	:	09/12/2018
Last Update Date	:	01/09/2024

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Directions to “PARTHENON MEDICAL PLLC ” Practice Location

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