Healthcare Provider Details

I. General information

NPI: 1194046888
Provider Name (Legal Business Name): ANDREEA POENARIU M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2010
Last Update Date: 10/22/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

836 PRUDENTIAL DRIVE SUITE 1502 PAVILION BLDG
JACKSONVILLE FL
32207
US

IV. Provider business mailing address

2 SHIRCLIFF WAY SUITE 700 DEPAUL BLDG.
JACKSONVILLE FL
32204-4763
US

V. Phone/Fax

Practice location:
  • Phone: 904-398-1111
  • Fax: 904-389-5332
Mailing address:
  • Phone: 904-389-5333
  • Fax: 904-389-5332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberME113399
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: