Healthcare Provider Details

I. General information

NPI: 1174852560
Provider Name (Legal Business Name): NAUTILUS HEALTH CARE GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2009
Last Update Date: 07/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5220 BELFORT RD S STE 130
JACKSONVILLE FL
32256
US

IV. Provider business mailing address

5220 BELFORT RD SUITE 130
JACKSONVILLE FL
32256
US

V. Phone/Fax

Practice location:
  • Phone: 727-867-5480
  • Fax: 888-507-9833
Mailing address:
  • Phone: 904-446-3701
  • Fax: 888-507-9833

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License NumberOS5236
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberOS5236
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code2083P0011X
TaxonomyUndersea and Hyperbaric Medicine (Preventive Medicine) Physician
License NumberOS5236
License Number StateFL

VIII. Authorized Official

Name: PAUL M. VAZQUEZ
Title or Position: PRESIDENT
Credential: D.O.
Phone: 727-642-4183