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General NPI Number Information
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NPI Number | 1710958756
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Entity Type | Organization
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Legal Business Name | THE CHESAPEAKE CENTER
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Dates
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Enumeration Date | 01/29/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2080 CHILD ST
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City | JACKSONVILLE
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State | FL
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Zip | 32214-5005
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Country | US
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Telephone | 904-542-7632
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Fax | 904-542-7623
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Provider Business Mailing Address
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Address Line | 2327 YELLOW JASMINE LN
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City | ORANGE PARK
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State | FL
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Zip | 32003-3370
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Country | US
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Telephone | 904-269-6226
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Fax |
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Authorized Official
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Title or Position | NURSE ANESTHETIST
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Name | MR. GEORGE PATRICK RILEY
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Credential | CRNA
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Telephone | 904-542-7632
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 286500000X
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Taxonomy Name | Military Hospital
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License Number | ARNP9230669
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License Number State | FL
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