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NPI Code Detail

MEDICARE: DIABETICO INTERNACIONAL, INC.

MEDICARE: DIABETICO INTERNACIONAL, 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
1261QM1300XMulti-Specialty Clinic/Center
2163WD0400XDiabetes Educator Registered Nurse3300612FL

General Provider Information

NPI Number : 1245554799
Entity Type Code : Organization
Provider Name (Legal Business Name) : DIABETICO INTERNACIONAL, INC.
Provider Business Mailing Address
First Line : 2520 UNIVERSITY BLVD W
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32217-2004
Country : US
Telephone Number : 904-914-8947
Fax Number : 904-895-4729
Provider Business Practice Location Address
First Line : 2520 UNIVERSITY BLVD W
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32217-2004
Country : US
Telephone Number : 904-914-8947
Fax Number : 904-895-4729
Authorized Official
Title or Position : PRESIDENT/CEO
Name : LAVERN WEBSTER-DOWELL
Credential : BSN,RN,CDE
Telephone Number : 904-253-7967
Provider Enumeration Date : 03/25/2010
Last Update Date : 10/14/2024

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1255495164 — TODD NELSON FURMAN P.T.
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Directions to “DIABETICO INTERNACIONAL, INC. ” Practice Location

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