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NPI Code Detail

MEDICARE: MEDGINA ETIENNE

MEDICARE: MEDGINA ETIENNE
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
1101Y00000XCounselor

General Provider Information

NPI Number : 1255878534
Entity Type Code : Individual
Provider Name (Legal Business Name) : MEDGINA ETIENNE
Provider Business Mailing Address
First Line : 1419 UNIVERSITY BLVD N
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32211-5249
Country : US
Telephone Number : 904-745-0067
Fax Number :
Provider Business Practice Location Address
First Line : 1419 UNIVERSITY BLVD N
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32211-5249
Country : US
Telephone Number : 904-745-0067
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/25/2017
Last Update Date : 01/25/2017

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Directions to “ MEDGINA ETIENNE ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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