Healthcare Provider Details

I. General information

NPI: 1770942260
Provider Name (Legal Business Name): NORTHEAST FLORIDA ENDOCRINE AND DIABETES ASSOCIATES, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2016
Last Update Date: 02/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 PLANTATION ISLAND DR S SUITE 203A
ST AUGUSTINE FL
32080-3108
US

IV. Provider business mailing address

915 W MONROE ST SUITE 200
JACKSONVILLE FL
32204-1177
US

V. Phone/Fax

Practice location:
  • Phone: 904-384-2240
  • Fax: 904-384-6055
Mailing address:
  • Phone: 904-384-2240
  • Fax: 904-384-6055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: MRS. DENA F CLAY
Title or Position: OFFICE MANAGER
Credential:
Phone: 904-384-2240