Healthcare Provider Details

I. General information

NPI: 1649272956
Provider Name (Legal Business Name): EMILY HOFF-SULLIVAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 01/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2820 GIBSON RD
JACKSONVILLE FL
32207-4804
US

IV. Provider business mailing address

PO BOX 17543
JACKSONVILLE FL
32245-7543
US

V. Phone/Fax

Practice location:
  • Phone: 904-399-3150
  • Fax: 904-399-3515
Mailing address:
  • Phone: 904-399-3150
  • Fax: 904-399-3515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number043649
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME0073341
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: