Healthcare Provider Details

I. General information

NPI: 1093389975
Provider Name (Legal Business Name): HYDRO INFUSIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2021
Last Update Date: 05/16/2021
Certification Date: 05/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14797 PHILIPS HWY STE 201
JACKSONVILLE FL
32256-3746
US

IV. Provider business mailing address

11 GRAY WOLF TRL
PONTE VEDRA FL
32081-6052
US

V. Phone/Fax

Practice location:
  • Phone: 904-567-3998
  • Fax: 904-567-5790
Mailing address:
  • Phone: 904-567-3998
  • Fax: 904-567-5790

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. TRAVIS JEFFORDS
Title or Position: MGR
Credential: DNP
Phone: 904-567-3998