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General NPI Number Information
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NPI Number | 1689585820
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Entity Type | Organization
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Legal Business Name | SRC1 FL LLC
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Dates
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Enumeration Date | 09/16/2026
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Last Update Date | 09/16/2026
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Provider Practice Location Address
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Address Line | 11915 BEACH BLVD STE 116
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City | JACKSONVILLE
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State | FL
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Zip | 32246-6707
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Country | US
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Telephone | 904-481-5090
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Fax |
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Provider Business Mailing Address
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Address Line | 11915 BEACH BLVD STE 116
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City | JACKSONVILLE
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State | FL
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Zip | 32246-6707
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Country | US
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Telephone | 904-481-5090
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | MR. STEVE FREANT
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Credential |
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Telephone | 407-712-3252
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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