MEDICARE: SVILA SKIN SOLUTIONS

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
1	282N00000X	General Acute Care Hospital	2898342	FL
2	302R00000X	Health Maintenance Organization	2898342	FL

General Provider Information

NPI Number	:	1255570974
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SVILA SKIN SOLUTIONS

Provider Business Mailing Address
First Line	:	1936 SAN MARCO BLVD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32207-3286
Country	:	US
Telephone Number	:	904-425-4410
Fax Number	:	904-425-4413

Provider Business Practice Location Address
First Line	:	1936 SAN MARCO BLVD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32207-3286
Country	:	US
Telephone Number	:	904-425-4410
Fax Number	:	904-425-4413

Authorized Official
Title or Position	:	ARNP/OWNER
Name	:	MARCIA ANN HAINES
Credential	:	NP
Telephone Number	:	904-425-4410

Provider Enumeration Date	:	02/19/2009
Last Update Date	:	02/19/2009

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1568070738 — BETH RENAE SCHLOMER RN, NNP-BC
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1790944700 — DR. VORBES ALEGER M.D.
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1200 RIVERPLACE BLVD , SUITE 620
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1255585857 — KELLY LYNN SHURMAN LMHC
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1710553334 — MEGHAN JEFFREY
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Directions to “SVILA SKIN SOLUTIONS ” Practice Location

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