Healthcare Provider Details

I. General information

NPI: 1518024462
Provider Name (Legal Business Name): BAPTIST MEDICAL CENTER OF NASSAU INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 06/02/2022
Certification Date: 06/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 S 18TH ST
FERNANDINA BEACH FL
32034-1902
US

IV. Provider business mailing address

PO BOX 44114
JACKSONVILLE FL
32231-4114
US

V. Phone/Fax

Practice location:
  • Phone: 904-376-4182
  • Fax: 904-376-4280
Mailing address:
  • Phone: 904-376-4182
  • Fax: 904-376-4280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number4355
License Number StateFL

VIII. Authorized Official

Name: PHILIP BOYCE
Title or Position: CHIEF REVENUE OFFICER
Credential:
Phone: 904-376-3760