Healthcare Provider Details

I. General information

NPI: 1003379975
Provider Name (Legal Business Name): NORTH FLORIDA SURGEONS, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2019
Last Update Date: 04/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1715 EAGLE HARBOR PKWY STE A
FLEMING ISLAND FL
32003-4324
US

IV. Provider business mailing address

11945 SAN JOSE BLVD STE 300
JACKSONVILLE FL
32223-1627
US

V. Phone/Fax

Practice location:
  • Phone: 904-215-2422
  • Fax: 904-215-6122
Mailing address:
  • Phone: 904-396-1725
  • Fax: 904-399-1717

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOHN P. BERLIN
Title or Position: CEO
Credential:
Phone: 904-396-1725