Healthcare Provider Details

I. General information

NPI: 1760438121
Provider Name (Legal Business Name): NATURAL MEDICINE AND WELLNESS CENTER OF JACKSONVILLE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4237 SALISBURY ROAD NORTH SUITE 110
JACKSONVILLE FL
32216
US

IV. Provider business mailing address

4237 SALISBURY ROAD NORTH SUITE 110
JACKSONVILLE FL
32216
US

V. Phone/Fax

Practice location:
  • Phone: 904-296-1116
  • Fax: 904-296-1467
Mailing address:
  • Phone: 904-296-1116
  • Fax: 904-296-1467

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License NumberHCC6915
License Number StateFL

VIII. Authorized Official

Name: DR. ALFONSO M BREMER
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 904-296-1116