MEDICARE: DR. WILLIE A PENNICK MD

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	207Q00000X	Family Medicine Physician	ME53419	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568426302
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIE A PENNICK MD

Provider Business Mailing Address
First Line	:	1760 EDGEWOOD AVE W
Second Line	:	SUITE B
City	:	JACKSONVILLE
State	:	FL
Zip	:	32208-7209
Country	:	US
Telephone Number	:	904-358-8480
Fax Number	:	904-358-8460

Provider Business Practice Location Address
First Line	:	1760 EDGEWOOD AVE W
Second Line	:	SUITE B
City	:	JACKSONVILLE
State	:	FL
Zip	:	32208-7209
Country	:	US
Telephone Number	:	904-358-8480
Fax Number	:	904-358-8460

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

Provider Enumeration Date	:	04/17/2006
Last Update Date	:	07/02/2014

Similar Medicare Providers

1518490069 — DR. VIKRAM ADITYA BALA DPM
Practice Location Address:

1760 EDGEWOOD AVE W # 1
JACKSONVILLE, FL
32208-7209

Practice Phone: 904-731-3131
Practice Fax: 904-731-0209

1194789958 — PENNIC, WOOTEN& ASSOCIATES FAMILY MEDICAL CARE PA
Practice Location Address:

1760 EDGEWOOD AVE W , B
JACKSONVILLE, FL
32208-7209

Practice Phone: 904-358-8480
Practice Fax: 904-358-8460

1811941677 — DR. JAMES L GENTRY MD
Practice Location Address:

1760 EDGEWOOD AVE W
JACKSONVILLE, FL
32208-7209

Practice Phone: 904-301-4900
Practice Fax: 904-924-1773

1851345714 — DR. KENNETH E NIXON MD
Practice Location Address:

1760 EDGEWOOD AVE W
JACKSONVILLE, FL
32208-7209

Practice Phone: 904-253-1030
Practice Fax: 904-924-1773

1013006691 — MARIA SUSAN MARTINEZ LCSW
Practice Location Address:

1760 EDGEWOOD AVE W
JACKSONVILLE, FL
32208-7209

Practice Phone: 904-301-4900
Practice Fax: 904-924-1773

1215059829 — LINDA LOU TISDALE ARNP
Practice Location Address:

1760 EDGEWOOD AVE W
JACKSONVILLE, FL
32208-7209

Practice Phone: 904-301-4900
Practice Fax: 904-924-1773

Directions to “ DR. WILLIE A PENNICK MD” 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.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.