Healthcare Provider Details

I. General information

NPI: 1215631536
Provider Name (Legal Business Name): RESHMA JIGNESH PATEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2023
Last Update Date: 03/29/2023
Certification Date: 03/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 KINGSLEY AVE
ORANGE PARK FL
32073-5156
US

IV. Provider business mailing address

2388 CLUB LAKE DR
ORANGE PARK FL
32065-2684
US

V. Phone/Fax

Practice location:
  • Phone: 904-639-8500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN9591046
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: