Healthcare Provider Details

I. General information

NPI: 1033128152
Provider Name (Legal Business Name): ERNST NICOLITZ MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2006
Last Update Date: 03/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7051 SOUTHPOINT PKWY 3RD FLOOR
JACKSONVILLE FL
32216-8709
US

IV. Provider business mailing address

7051 SOUTHPOINT PKWY 3RD FLOOR
JACKSONVILLE FL
32216-8713
US

V. Phone/Fax

Practice location:
  • Phone: 904-398-2720
  • Fax: 904-398-6408
Mailing address:
  • Phone: 904-398-2720
  • Fax: 904-483-5640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberME31869
License Number StateFL

VIII. Authorized Official

Name: ERNST NICOLITZ
Title or Position: PRESIDENT
Credential: M.D.
Phone: 904-398-2720