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NPI Code Detail

MEDICARE: UNIVERSITY OF FLORIDA JACKSONVILLE PHYSICIANS, INC.

MEDICARE: UNIVERSITY OF FLORIDA JACKSONVILLE PHYSICIANS, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician

General Provider Information

NPI Number : 1104495977
Entity Type Code : Organization
Provider Name (Legal Business Name) : UNIVERSITY OF FLORIDA JACKSONVILLE PHYSICIANS, INC.
Provider Business Mailing Address
First Line : PO BOX 44008
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32231-4008
Country : US
Telephone Number : 904-244-3660
Fax Number :
Provider Business Practice Location Address
First Line : 3122 NEW BERLIN RD
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32226-1828
Country : US
Telephone Number : 904-633-0340
Fax Number : 904-633-0341
Authorized Official
Title or Position : DIRECTOR
Name : MS. WENDEY CLARKE LANDKROHN
Credential :
Telephone Number : 904-244-3603
Provider Enumeration Date : 06/24/2021
Last Update Date : 06/24/2021

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Directions to “UNIVERSITY OF FLORIDA JACKSONVILLE PHYSICIANS, INC. ” Practice Location

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