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NPI Code Detail

MEDICARE: UNIVERSITY OF FLORIDA JACKSONVILLE PHYSICIANS INC

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
12084P0804XChild & Adolescent Psychiatry Physician

General Provider Information

NPI Number : 1639842248
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 : 904-244-3592
Provider Business Practice Location Address
First Line : 6271 ST AUGUSTINE RD
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32217-2555
Country : US
Telephone Number : 904-633-0750
Fax Number : 904-633-0751
Authorized Official
Title or Position : DIRECTOR
Name : MS. WENDEY CLARKE LANDKROHN
Credential :
Telephone Number : 904-244-3603
Provider Enumeration Date : 07/29/2021
Last Update Date : 07/29/2021

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Directions to “UNIVERSITY OF FLORIDA JACKSONVILLE PHYSICIANS INC ” Practice Location

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