Healthcare Provider Details

I. General information

NPI: 1619476785
Provider Name (Legal Business Name): SYNERGY HEALTH GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2018
Last Update Date: 02/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7828 COLLINS GROVE RD
JACKSONVILLE FL
32256-7175
US

IV. Provider business mailing address

2735 UNIVERSITY BLVD S
JACKSONVILLE FL
32216-2548
US

V. Phone/Fax

Practice location:
  • Phone: 904-721-0894
  • Fax: 904-721-9449
Mailing address:
  • Phone: 904-721-0894
  • Fax: 904-721-9449

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberME90169
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberME97437
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License NumberME90169
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License NumberME97437
License Number StateFL

VIII. Authorized Official

Name: MRS. CRYSTAL HALL
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 904-721-0894