Healthcare Provider Details

I. General information

NPI: 1528680220
Provider Name (Legal Business Name): FLORIDA INJURY & REGENERATIVE MEDICINE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2020
Last Update Date: 04/07/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3033 HARTLEY RD STE 6
JACKSONVILLE FL
32257-6280
US

IV. Provider business mailing address

101 MARKETSIDE AVE # 404-777
PONTE VEDRA FL
32081-1541
US

V. Phone/Fax

Practice location:
  • Phone: 190-448-1111
  • Fax: 832-442-3800
Mailing address:
  • Phone: 904-481-1111
  • Fax: 832-442-3800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. KIRT W REPP
Title or Position: MEMBER / AUTHORIZED REPRESENTATIVE
Credential:
Phone: 281-831-6290