Healthcare Provider Details

I. General information

NPI: 1457286205
Provider Name (Legal Business Name): NORTHEAST FLORIDA ENDOCRINE AND DIABETES ASSOCIATES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2511 SAINT JOHNS BLUFF RD S STE 201
JACKSONVILLE FL
32246-2345
US

IV. Provider business mailing address

915 W MONROE ST STE 200
JACKSONVILLE FL
32204-1177
US

V. Phone/Fax

Practice location:
  • Phone: 904-384-2240
  • Fax: 904-486-2314
Mailing address:
  • Phone: 904-384-2240
  • Fax: 904-486-2314

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: ELENA M ORAVETZ
Title or Position: CREDENTIALING
Credential:
Phone: 904-384-2240