Healthcare Provider Details

I. General information

NPI: 1164988028
Provider Name (Legal Business Name): RAYMOND DAO NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2019
Last Update Date: 08/19/2022
Certification Date: 10/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 SHIRCLIFF WAY
JACKSONVILLE FL
32204-4748
US

IV. Provider business mailing address

7868 KNOLL DR N
JACKSONVILLE FL
32221-6126
US

V. Phone/Fax

Practice location:
  • Phone: 904-308-2200
  • Fax:
Mailing address:
  • Phone: 904-404-7512
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number9265580
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberAPRN1109380
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberAPRN1109380
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAPRN11009380
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: