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General NPI Number Information
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NPI Number | 1801569181
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Entity Type | Organization
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Legal Business Name | DISCOVERY HEALTH ZONE
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Dates
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Enumeration Date | 08/01/2021
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Last Update Date | 08/01/2021
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Provider Practice Location Address
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Address Line | 101 W 48TH ST
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City | JACKSONVILLE
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State | FL
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Zip | 32208-5232
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Country | US
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Telephone | 904-773-4567
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Fax | 628-200-2178
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Provider Business Mailing Address
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Address Line | 7956 DAWSONS CREEK DR
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City | JACKSONVILLE
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State | FL
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Zip | 32222-4907
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Country | US
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Telephone | 904-955-7575
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. STACEY NICOLE HARDEN
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Credential | NURSE PRACTITIONER
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Telephone | 904-773-4567
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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