MEDICARE: COGENT HEALTHCARE OF JACKSONVILLE, LLC

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	207R00000X	Internal Medicine Physician

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	:	1770166928
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COGENT HEALTHCARE OF JACKSONVILLE, LLC

Provider Business Mailing Address
First Line	:	5410 MARYLAND WAY STE 300
Second Line	:
City	:	BRENTWOOD
State	:	TN
Zip	:	37027-5339
Country	:	US
Telephone Number	:	615-577-6340
Fax Number	:

Provider Business Practice Location Address
First Line	:	1330 S ANDREWS AVE
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33316-1838
Country	:	US
Telephone Number	:	954-524-5587
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MELISSA HARLAN
Credential	:
Telephone Number	:	615-577-6340

Provider Enumeration Date	:	05/04/2021
Last Update Date	:	05/04/2021

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