Healthcare Provider Details

I. General information

NPI: 1972341147
Provider Name (Legal Business Name): ILLUMIA HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2024
Last Update Date: 05/16/2025
Certification Date: 05/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8130 BAYMEADOWS WAY W STE 201
JACKSONVILLE FL
32256-7451
US

IV. Provider business mailing address

PO BOX 4060 ATTN: REGULATORY
MOORESVILLE NC
28117-4060
US

V. Phone/Fax

Practice location:
  • Phone: 740-988-5042
  • Fax:
Mailing address:
  • Phone: 704-664-2876
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: JANET L. COMBS
Title or Position: VP OF LICENSURE
Credential:
Phone: 704-662-1761