Healthcare Provider Details

I. General information

NPI: 1972538106
Provider Name (Legal Business Name): DANIEL J CEGLOWSKI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 05/16/2025
Certification Date: 05/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 CORPORATE SQUARE BLVD
JACKSONVILLE FL
32216-1941
US

IV. Provider business mailing address

1900 CORPORATE SQUARE BLVD
JACKSONVILLE FL
32216-1941
US

V. Phone/Fax

Practice location:
  • Phone: 866-552-6557
  • Fax: 866-797-6949
Mailing address:
  • Phone: 904-513-5824
  • Fax: 866-797-6949

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number4301080382
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number4301080382
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License Number2021-01167
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License Number181231
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number2021-01167
License Number StateNC
# 6
Primary TaxonomyY
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License Number171734
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: