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General NPI Number Information
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NPI Number | 1508827304
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Entity Type | Individual
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Provider Name | TODD WURTZ PA-C
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Gender | Male
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Dates
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Enumeration Date | 03/31/2006
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Last Update Date | 09/23/2024
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Provider Practice Location Address
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Address Line | 8262 POINT MEADOWS DR STE 201
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City | JACKSONVILLE
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State | FL
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Zip | 32256-4702
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Country | US
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Telephone | 904-288-8311
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Fax | 904-288-8371
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Provider Business Mailing Address
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Address Line | 705 WELLS RD STE 300
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City | ORANGE PARK
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State | FL
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Zip | 32073-2982
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Country | US
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Telephone | 904-282-6331
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Fax | 904-619-1080
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA9103673
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License Number State | FL
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