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General NPI Number Information
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NPI Number | 1639835465
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Entity Type | Organization
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Legal Business Name | COGENT HEALTHCARE OF JACKSONVILLE, LLC
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Dates
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Enumeration Date | 11/16/2021
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Last Update Date | 11/16/2021
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Provider Practice Location Address
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Address Line | 2770 REGENCY OAKS BLVD
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City | CLEARWATER
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State | FL
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Zip | 33759-1509
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Country | US
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Telephone | 727-791-7743
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Fax |
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Provider Business Mailing Address
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Address Line | 5410 MARYLAND WAY STE 300
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City | BRENTWOOD
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State | TN
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Zip | 37027-5339
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Country | US
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Telephone | 866-282-7905
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Fax | 855-206-2136
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Authorized Official
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Title or Position | DIRECTOR OF PAYER ENROLLMENT
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Name | MELISSA HARLAN
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Credential |
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Telephone | 615-577-6340
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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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