MEDICARE: UNIVERSITY OF FLORIDA JACKSONVILLE PHYSICIANS, INC.

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

General Provider Information

NPI Number	:	1588233779
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIVERSITY OF FLORIDA JACKSONVILLE PHYSICIANS, INC.

Provider Business Mailing Address
First Line	:	PO BOX 44008
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32231-4008
Country	:	US
Telephone Number	:	904-244-3660
Fax Number	:

Provider Business Practice Location Address
First Line	:	7645 MERRILL RD STE 301
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32277-6575
Country	:	US
Telephone Number	:	904-633-0285
Fax Number	:	904-633-0286

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MS. WENDEY CLARKE LANDKROHN
Credential	:
Telephone Number	:	904-244-3603

Provider Enumeration Date	:	06/22/2021
Last Update Date	:	06/22/2021

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