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General NPI Number Information
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NPI Number | 1124380969
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Entity Type | Organization
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Legal Business Name | MEMORIAL HOSPITAL
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Dates
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Enumeration Date | 06/07/2012
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Last Update Date | 06/07/2012
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Provider Practice Location Address
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Address Line | 3625 UNIVERSITY BLVD S
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City | JACKSONVILLE
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State | FL
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Zip | 32216-4207
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Country | US
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Telephone | 904-399-6111
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Fax |
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Provider Business Mailing Address
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Address Line | 3625 UNIVERSITY BLVD S
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City | JACKSONVILLE
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State | FL
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Zip | 32216-4207
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Country | US
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Telephone | 904-399-6111
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Fax |
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Authorized Official
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Title or Position | FAMILY NURSE PRACTITIONER
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Name | MR. ANDREW DAVID GREEN
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Credential | ARNP
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Telephone | 904-391-1534
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number | ARNP9176315
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License Number State | FL
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