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General NPI Number Information
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NPI Number | 1669482543
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Entity Type | Individual
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Provider Name | SUSAN NEIMS GRECO M.D., M.P.H.
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Gender | Female
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Dates
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Enumeration Date | 08/09/2006
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Last Update Date | 02/18/2016
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Provider Practice Location Address
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Address Line | 4085 UNIVERSITY BLVD S SUITE 1
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City | JACKSONVILLE
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State | FL
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Zip | 32216-4357
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Country | US
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Telephone | 904-730-0101
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Fax | 904-730-0121
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Provider Business Mailing Address
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Address Line | 11714 EXMOOR CT SUITE 1
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City | JACKSONVILLE
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State | FL
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Zip | 32256-2911
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Country | US
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Telephone | 904-997-7166
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME0074490
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License Number State | FL
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