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General NPI Number Information
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NPI Number | 1174356554
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Entity Type | Organization
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Legal Business Name | JAX HEALTHCARE LLC
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Dates
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Enumeration Date | 08/21/2024
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Last Update Date | 05/07/2025
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Provider Practice Location Address
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Address Line | 11512 LAKE MEAD AVE UNIT 702
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City | JACKSONVILLE
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State | FL
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Zip | 32256-9681
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Country | US
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Telephone | 904-586-2527
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Fax |
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Provider Business Mailing Address
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Address Line | 2222 WALKERS GLEN LN
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City | JACKSONVILLE
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State | FL
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Zip | 32246-7176
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | YURIEL GONZALEZ EXPOSITO
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Credential |
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Telephone | 305-494-1100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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