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General NPI Number Information
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NPI Number | 1366249765
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Entity Type | Individual
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Provider Name | MR. IAN NEILH FLORESCA
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Gender | Male
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Dates
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Enumeration Date | 02/25/2025
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Last Update Date | 02/25/2025
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Provider Practice Location Address
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Address Line | 2080 CHILD ST FL 32214
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City | JACKSONVILLE
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State | FL
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Zip | 32214-5005
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Country | US
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Telephone | 904-542-9438
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Fax |
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Provider Business Mailing Address
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Address Line | 10809 AVENUES WALK BLVD
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City | JACKSONVILLE
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State | FL
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Zip | 32258-1758
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Country | US
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Telephone | 571-572-8611
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 246Z00000X
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Taxonomy Name | Other Specialist/Technologist
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License Number |
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License Number State |
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