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General NPI Number Information
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NPI Number | 1932680469
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Entity Type | Organization
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Legal Business Name | FLORIDA PHYSICIAN SPECIALISTS LLC
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Dates
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Enumeration Date | 08/23/2018
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Last Update Date | 12/26/2024
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Provider Practice Location Address
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Address Line | 1860 TOWN HALL CIR
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City | FLEMING ISLAND
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State | FL
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Zip | 32003-4331
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Country | US
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Telephone | 904-520-6800
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Fax | 904-520-6801
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Provider Business Mailing Address
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Address Line | 7017 A C SKINNER PKWY
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City | JACKSONVILLE
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State | FL
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Zip | 32256-6932
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Country | US
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Telephone | 904-520-6800
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Fax | 904-520-6801
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Authorized Official
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Title or Position | CFO
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Name | MEAGHAN COLLEEN LUTZ
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Credential |
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Telephone | 904-520-6800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332900000X
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Taxonomy Name | Non-Pharmacy Dispensing Site
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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