Healthcare Provider Details

I. General information

NPI: 1578135950
Provider Name (Legal Business Name): UNIVERSITY OF FLORIDA JACKSONVILLE PHYSICIANS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2021
Last Update Date: 07/14/2021
Certification Date: 07/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1887 KINGSLEY AVE
ORANGE PARK FL
32073-4481
US

IV. Provider business mailing address

PO BOX 44008
JACKSONVILLE FL
32231-4008
US

V. Phone/Fax

Practice location:
  • Phone: 904-633-0880
  • Fax: 904-633-0881
Mailing address:
  • Phone: 904-244-3660
  • Fax: 904-244-3592

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. WENDEY CLARKE LANDKROHN
Title or Position: DIRECTOR
Credential:
Phone: 904-244-3603