Healthcare Provider Details

I. General information

NPI: 1205368917
Provider Name (Legal Business Name): VARVARA PROBST M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2017
Last Update Date: 03/30/2020
Certification Date: 03/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

653-1 W 8TH ST FL 4
JACKSONVILLE FL
32209-6511
US

IV. Provider business mailing address

D-7235 MEDICAL CENTER NORTH 1161 21ST AVE S
NASHVILLE TN
37232-2581
US

V. Phone/Fax

Practice location:
  • Phone: 904-633-4199
  • Fax: 904-633-4188
Mailing address:
  • Phone: 615-322-2250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: