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General NPI Number Information
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NPI Number | 1801044268
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Entity Type | Organization
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Legal Business Name | ALL WOMEN'S HEALTH CENTER OF JACKSONVILLE, INC.
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Dates
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Enumeration Date | 08/28/2008
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Last Update Date | 08/28/2008
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Provider Practice Location Address
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Address Line | 4331 UNIVERSITY BLVD S
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City | JACKSONVILLE
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State | FL
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Zip | 32216-4909
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Country | US
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Telephone | 904-731-2755
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Fax | 904-730-7376
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Provider Business Mailing Address
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Address Line | 2106 DREW ST STE 103
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City | CLEARWATER
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State | FL
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Zip | 33765-3238
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Country | US
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Telephone | 727-442-0445
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Fax | 727-447-3797
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Authorized Official
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Title or Position | BILLING AND CONTRACT MANAGER
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Name | MARISELLA MARENGO
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Credential |
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Telephone | 727-442-0445
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number | 800
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License Number State | FL
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