Healthcare Provider Details

I. General information

NPI: 1003698184
Provider Name (Legal Business Name): ANAVA EMERGENCY CONSULTANTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2023
Last Update Date: 10/17/2023
Certification Date: 10/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

159 N 3RD ST
MACCLENNY FL
32063-2103
US

IV. Provider business mailing address

1640 ABERDEEN ST
JACKSONVILLE FL
32205-8636
US

V. Phone/Fax

Practice location:
  • Phone: 904-259-3151
  • Fax:
Mailing address:
  • Phone: 727-515-3119
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0002X
TaxonomyEmergency Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: GRANT P BARKER
Title or Position: PRESIDENT
Credential: MD
Phone: 727-515-3119