MEDICARE: NEIL NESBITT

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	1-24-73136

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	:	1467189225
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NEIL NESBITT

Provider Business Mailing Address
First Line	:	12276 SAN JOSE BLVD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32223-8628
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6817 SOUTHPOINT PKWY STE 2002
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-6299
Country	:	US
Telephone Number	:	904-895-5865
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/02/2022
Last Update Date	:	10/08/2024

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Directions to “ NEIL NESBITT ” Practice Location

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