Healthcare Provider Details

I. General information

NPI: 1508827304
Provider Name (Legal Business Name): TODD WURTZ PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2006
Last Update Date: 09/23/2024
Certification Date: 09/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8262 POINT MEADOWS DR STE 201
JACKSONVILLE FL
32256-4702
US

IV. Provider business mailing address

705 WELLS RD STE 300
ORANGE PARK FL
32073-2982
US

V. Phone/Fax

Practice location:
  • Phone: 904-288-8311
  • Fax: 904-288-8371
Mailing address:
  • Phone: 904-282-6331
  • Fax: 904-619-1080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9103673
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: