Healthcare Provider Details

I. General information

NPI: 1396355822
Provider Name (Legal Business Name): HDAP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2020
Last Update Date: 08/10/2020
Certification Date: 08/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 EXECUTIVE WAY STE 110
PONTE VEDRA BEACH FL
32082-2788
US

IV. Provider business mailing address

35 EXECUTIVE WAY STE 110
PONTE VEDRA BEACH FL
32082-2788
US

V. Phone/Fax

Practice location:
  • Phone: 904-285-2019
  • Fax: 904-285-2779
Mailing address:
  • Phone: 904-285-2019
  • Fax: 904-285-2779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: MR. CHRISTOPHER ELIAS MARGOLIN
Title or Position: CEO
Credential:
Phone: 924-285-2019