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General NPI Number Information
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NPI Number | 1487724993
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Entity Type | Organization
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Legal Business Name | N E FLORIDA INTERNAL MEDICINE PA
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Dates
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Enumeration Date | 11/09/2006
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Last Update Date | 12/23/2010
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Provider Practice Location Address
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Address Line | 2065 HERSCHEL ST
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City | JACKSONVILLE
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State | FL
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Zip | 32204-3817
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Country | US
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Telephone | 904-387-4050
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Fax | 904-387-4860
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Provider Business Mailing Address
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Address Line | 2065 HERSCHEL STREET
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City | JACKSONVILLE
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State | FL
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Zip | 32204-3817
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Country | US
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Telephone | 904-387-4050
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Fax | 904-387-4860
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Authorized Official
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Title or Position | PRESIDENT
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Name | ELYSSA BLISSENBACH
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Credential | MD PA
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Telephone | 904-387-4050
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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