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General NPI Number Information
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NPI Number | 1861150625
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Entity Type | Organization
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Legal Business Name | COGENT HEALTHCARE OF JACKSONVILLE, LLC
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Dates
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Enumeration Date | 11/29/2021
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Last Update Date | 03/07/2025
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Provider Practice Location Address
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Address Line | 1515 HERBERT ST STE 210
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City | PORT ORANGE
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State | FL
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Zip | 32129-6105
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Country | US
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Telephone | 386-788-8313
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Fax |
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Provider Business Mailing Address
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Address Line | 5410 MARYLAND WAY STE 300
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City | BRENTWOOD
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State | TN
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Zip | 37027-5339
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Country | US
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Telephone | 866-282-7905
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | LAURA FALL
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Credential |
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Telephone | 253-682-6040
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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