Healthcare Provider Details

I. General information

NPI: 1801143342
Provider Name (Legal Business Name): ARASTOO T NABIZADEH MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2012
Last Update Date: 08/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6816 SOUTHPOINT PKWY STE 201
JACKSONVILLE FL
32216-1701
US

IV. Provider business mailing address

PO BOX 17809
JACKSONVILLE FL
32245-7809
US

V. Phone/Fax

Practice location:
  • Phone: 904-281-1164
  • Fax: 904-281-7732
Mailing address:
  • Phone: 904-723-5665
  • Fax: 904-338-0951

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberME72727
License Number StateFL

VIII. Authorized Official

Name: ARASTOO T NABIZADEH
Title or Position: PRESIDENT
Credential: MD
Phone: 904-281-1164