Healthcare Provider Details

I. General information

NPI: 1154078483
Provider Name (Legal Business Name): COGENT HEALTHCARE OF JACKSONVILLE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2022
Last Update Date: 03/07/2022
Certification Date: 03/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 SE 8TH AVE
CRYSTAL RIVER FL
34429-4855
US

IV. Provider business mailing address

5410 MARYLAND WAY STE 300
BRENTWOOD TN
37027-5339
US

V. Phone/Fax

Practice location:
  • Phone: 239-310-5907
  • Fax:
Mailing address:
  • Phone: 866-765-0513
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MELISSA HARLAN
Title or Position: DIRECTOR OF PAYER ENROLLMENT
Credential:
Phone: 615-577-6340