MEDICARE: MANAGE VINCENT

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	363LF0000X	Family Nurse Practitioner	APRN11038105	FL
2	163W00000X	Registered Nurse	843388	NY
3	363LF0000X	Family Nurse Practitioner	355121	NY

General Provider Information

NPI Number	:	1326818915
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MANAGE VINCENT

Provider Business Mailing Address
First Line	:	PO BOX 44008
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32231-4008
Country	:	US
Telephone Number	:	904-383-1040
Fax Number	:	904-427-8996

Provider Business Practice Location Address
First Line	:	1155 E 21ST ST
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32206-2401
Country	:	US
Telephone Number	:	904-383-1040
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/04/2024
Last Update Date	:	04/26/2026

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Directions to “ MANAGE VINCENT ” Practice Location

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