Healthcare Provider Details

I. General information

NPI: 1144822628
Provider Name (Legal Business Name): DOCVISITS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2020
Last Update Date: 11/10/2020
Certification Date: 11/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6742 RHODE ISLAND DR W
JACKSONVILLE FL
32209-1436
US

IV. Provider business mailing address

6742 RHODE ISLAND DR W
JACKSONVILLE FL
32209-1436
US

V. Phone/Fax

Practice location:
  • Phone: 904-738-9533
  • Fax: 904-438-5211
Mailing address:
  • Phone: 904-357-0277
  • Fax: 904-438-5211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RT0003X
TaxonomyTransplant Hepatology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MR. DALLAS EVANS
Title or Position: CHIEF PRACTITIONER
Credential: APRN
Phone: 904-438-5211