Healthcare Provider Details

I. General information

NPI: 1891009262
Provider Name (Legal Business Name): NAVAL HOSPITAL JACKSONVILLE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2010
Last Update Date: 07/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2080 CHILD ST
JACKSONVILLE FL
32214-5000
US

IV. Provider business mailing address

2080 CHILD ST
JACKSONVILLE FL
32214-5000
US

V. Phone/Fax

Practice location:
  • Phone: 904-542-9790
  • Fax:
Mailing address:
  • Phone: 904-542-9790
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. MARIE ELIZABETH BROCK
Title or Position: FAMILY MEDICINE INTERN
Credential: D.O.
Phone: 423-718-7850