Healthcare Provider Details

I. General information

NPI: 1598015133
Provider Name (Legal Business Name): NAGULA & ASSOCIATES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2012
Last Update Date: 10/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1361 13TH AVE S SUITE 140
JACKSONVILLE BEACH FL
32250-3233
US

IV. Provider business mailing address

1361 13TH AVE S SUITE 140
JACKSONVILLE BEACH FL
32250-3233
US

V. Phone/Fax

Practice location:
  • Phone: 904-261-8400
  • Fax: 904-261-2255
Mailing address:
  • Phone: 904-261-8400
  • Fax: 904-261-2255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: DIWAKAR NAGULA
Title or Position: OWNER
Credential: D.O.
Phone: 912-673-7074