Healthcare Provider Details

I. General information

NPI: 1851245047
Provider Name (Legal Business Name): JACKSONVILLE EP PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2026
Last Update Date: 02/27/2026
Certification Date: 02/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12625 BEACH BLVD
JACKSONVILLE FL
32246
US

IV. Provider business mailing address

6030 S RICE AVE STE C
HOUSTON TX
77081-2944
US

V. Phone/Fax

Practice location:
  • Phone: 713-660-0557
  • Fax:
Mailing address:
  • Phone: 713-660-0557
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: KEELYN MARLATT
Title or Position: DIRECTOR OF REVENUE CYCLE
Credential:
Phone: 713-660-0557