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General NPI Number Information
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NPI Number | 1730774142
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Entity Type | Organization
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Legal Business Name | SALUD PRIMARY CARE LLC
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Dates
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Enumeration Date | 03/08/2021
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Last Update Date | 03/08/2021
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Provider Practice Location Address
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Address Line | 1126 UNIVERSITY BLVD N STE 3105
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City | JACKSONVILLE
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State | FL
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Zip | 32211-8850
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Country | US
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Telephone | 904-625-2644
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Fax |
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Provider Business Mailing Address
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Address Line | 379 TINTAMARRE DR
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City | SAINT AUGUSTINE
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State | FL
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Zip | 32092-1102
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Country | US
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Telephone | 904-625-2644
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JOHANNA RUSSELL
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Credential | NP
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Telephone | 904-625-2644
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number |
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License Number State |
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