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General NPI Number Information
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NPI Number | 1932202322
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Entity Type | Organization
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Legal Business Name | NORTHEAST FLORIDA STATE HOSPITAL
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Dates
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Enumeration Date | 09/07/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 7487 S STATE ROAD 121
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City | MACCLENNY
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State | FL
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Zip | 32063-5451
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Country | US
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Telephone | 904-259-6211
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Fax | 904-259-7104
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Provider Business Mailing Address
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Address Line | 7487 S STATE ROAD 121
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City | MACCLENNY
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State | FL
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Zip | 32063-5451
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Country | US
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Telephone | 904-259-6211
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Fax | 904-259-7104
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Authorized Official
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Title or Position | SENIOR PHYSICIAN
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Name | DR. OLGA INES ARIAS
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Credential | D.O.
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Telephone | 904-259-6211
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0805X
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Taxonomy Name | Geriatric Psychiatry Physician
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License Number | OS 7547
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License Number State | FL
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