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General NPI Number Information
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NPI Number | 1891748257
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Entity Type | Organization
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Legal Business Name | FLORIDA PROTON THERAPY INSTITUTE INC
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Dates
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Enumeration Date | 05/18/2006
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Last Update Date | 12/05/2024
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Provider Practice Location Address
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Address Line | 2015 JEFFERSON ST
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City | JACKSONVILLE
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State | FL
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Zip | 32206-3531
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Country | US
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Telephone | 904-588-1263
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Fax | 904-588-1300
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Provider Business Mailing Address
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Address Line | 2015 JEFFERSON ST
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City | JACKSONVILLE
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State | FL
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Zip | 32206-3531
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Country | US
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Telephone | 904-588-1401
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Fax | 904-588-1437
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Authorized Official
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Title or Position | DIRECTOR, ACTIVE, ATTENDING
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Name | NANCY MEDENHALL
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Credential | MD
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Telephone | 904-588-1401
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | ME39054
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License Number State | FL
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