Healthcare Provider Details

I. General information

NPI: 1366016016
Provider Name (Legal Business Name): JOSEPH ALLAN WEISS RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2021
Last Update Date: 05/17/2021
Certification Date: 05/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 PRUDENTIAL DR
JACKSONVILLE FL
32207-8211
US

IV. Provider business mailing address

1010 N 102ND ST STE 300
OMAHA NE
68114-2122
US

V. Phone/Fax

Practice location:
  • Phone: 904-202-2000
  • Fax:
Mailing address:
  • Phone: 402-758-2800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number28213853A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: