Healthcare Provider Details

I. General information

NPI: 1356454581
Provider Name (Legal Business Name): EUGENIA JANE NGO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: EUGENIA JANE NGO-SEIDEL MD

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1845 TOWN CENTER BLVD BLDG 400
FLEMING ISLAND FL
32003-3356
US

IV. Provider business mailing address

1845 TOWN CENTER BLVD. BLDG. 600, BOX #15
FERNANDINA BEACH FL
32003
US

V. Phone/Fax

Practice location:
  • Phone: 904-529-2800
  • Fax: 904-529-2802
Mailing address:
  • Phone: 904-529-2800
  • Fax: 904-529-2802

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME48868
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: