Healthcare Provider Details

I. General information

NPI: 1912462771
Provider Name (Legal Business Name): PARABRAHMA PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2019
Last Update Date: 04/16/2020
Certification Date: 04/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6100 GREENLAND RD STE 301
JACKSONVILLE FL
32258-2626
US

IV. Provider business mailing address

6100 GREENLAND RD STE 301
JACKSONVILLE FL
32258-2626
US

V. Phone/Fax

Practice location:
  • Phone: 904-337-9494
  • Fax: 904-293-1328
Mailing address:
  • Phone: 904-337-9494
  • Fax: 904-293-1328

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207QA0000X
TaxonomyAdolescent Medicine (Family Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: NETRALI PATEL
Title or Position: PRESIDENT
Credential: MD
Phone: 904-337-9494