Healthcare Provider Details

I. General information

NPI: 1700553856
Provider Name (Legal Business Name): SOUTHERN BAPTIST HOSPITAL OF FLORIDA, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2021
Last Update Date: 08/26/2021
Certification Date: 08/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 PRUDENTIAL DR
JACKSONVILLE FL
32207-8202
US

IV. Provider business mailing address

PO BOX 45094
JACKSONVILLE FL
32232-5094
US

V. Phone/Fax

Practice location:
  • Phone: 904-202-2000
  • Fax:
Mailing address:
  • Phone: 904-202-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC2000X
TaxonomyChildren's Hospital
License Number
License Number State

VIII. Authorized Official

Name: SUSAN HIGGINBOTHAM
Title or Position: DIRECTOR REVENUE CYCLE
Credential:
Phone: 904-376-4155