Healthcare Provider Details

I. General information

NPI: 1245802545
Provider Name (Legal Business Name): ERWIN VINCENT TORRALBA ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2021
Last Update Date: 07/15/2021
Certification Date: 06/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8245 BAYBERRY RD
JACKSONVILLE FL
32256-7432
US

IV. Provider business mailing address

8555 HOLLYRIDGE RD
JACKSONVILLE FL
32256-7244
US

V. Phone/Fax

Practice location:
  • Phone: 904-296-7775
  • Fax:
Mailing address:
  • Phone: 904-445-7222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11012758
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: