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General NPI Number Information
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NPI Number | 1669161840
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Entity Type | Organization
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Legal Business Name | SEVICK LLC
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Dates
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Enumeration Date | 05/03/2023
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Last Update Date | 02/03/2025
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Provider Practice Location Address
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Address Line | 1532 KINGSLEY AVE STE 108
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City | ORANGE PARK
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State | FL
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Zip | 32073-4536
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Country | US
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Telephone | 904-300-5982
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Fax |
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Provider Business Mailing Address
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Address Line | 6100 GREENLAND RD STE 303
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City | JACKSONVILLE
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State | FL
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Zip | 32258-2626
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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 | PROVIDER, CEO
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Name | MICHAEL L SEVICK
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Credential | NP
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Telephone | 904-300-5982
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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