Healthcare Provider Details

I. General information

NPI: 1982141057
Provider Name (Legal Business Name): EDUARDO CORVISON RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2017
Last Update Date: 01/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2104 MASSEY AVE NBHC NAVAL STATION MAYPORT
JACKSONVILLE FL
32228-0148
US

IV. Provider business mailing address

2104 MASSEY AVE NBHC NAVAL STATION MAYPORT
JACKSONVILLE FL
32228-0148
US

V. Phone/Fax

Practice location:
  • Phone: 904-270-4229
  • Fax: 904-827-4485
Mailing address:
  • Phone: 904-270-4229
  • Fax: 904-827-4485

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0106X
TaxonomyOccupational Health Registered Nurse
License NumberRN 9345351
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: