Healthcare Provider Details

I. General information

NPI: 1093061723
Provider Name (Legal Business Name): GERARDO AUGUSTO MONTANEZ GALVIS ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2012
Last Update Date: 09/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 DUNN AVE SUITE 1
JACKSONVILLE FL
32218-6330
US

IV. Provider business mailing address

6520 FORT CAROLINE RD
JACKSONVILLE FL
32277-2044
US

V. Phone/Fax

Practice location:
  • Phone: 904-696-7474
  • Fax: 904-696-7476
Mailing address:
  • Phone: 904-745-3618
  • Fax: 904-722-4271

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9285572
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: