MEDICARE: TEJASKUMAR M PATEL

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	183500000X	Pharmacist	PS41608	FL
2	376K00000X	Nurse's Aide

General Provider Information

NPI Number	:	1417276916
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TEJASKUMAR M PATEL

Provider Business Mailing Address
First Line	:	7628 103RD ST STE 5
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32210-8719
Country	:	US
Telephone Number	:	904-900-3500
Fax Number	:	904-900-3505

Provider Business Practice Location Address
First Line	:	10915 BAYMEADOWS RD STE 109
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-9131
Country	:	US
Telephone Number	:	904-217-3099
Fax Number	:

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

Provider Enumeration Date	:	05/24/2010
Last Update Date	:	01/25/2026

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