Healthcare Provider Details

I. General information

NPI: 1851521967
Provider Name (Legal Business Name): NAVAL HOSPITAL AT JACKSONVILLE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2009
Last Update Date: 07/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2080 CHILD ST
JACKSONVILLE FL
32214-5005
US

IV. Provider business mailing address

2080 CHILD ST
JACKSONVILLE FL
32214-5005
US

V. Phone/Fax

Practice location:
  • Phone: 904-542-7762
  • Fax:
Mailing address:
  • Phone: 904-542-7762
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code286500000X
TaxonomyMilitary Hospital
License Number390200000X
License Number State

VIII. Authorized Official

Name: VICKIE WOLFE
Title or Position: GME COORDINATOR
Credential:
Phone: 904-542-7762