MEDICARE: EMILY HOFF-SULLIVAN M.D.

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	174400000X	Specialist	043649	GA
2	174400000X	Specialist	ME0073341	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	200027956	OTHER	GA	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	162188000	OTHER	GA	US DOL
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	41456	OTHER	FL	BCBS
5	4299040001	OTHER	GA	DME

General Provider Information

NPI Number	:	1649272956
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY HOFF-SULLIVAN M.D.

Provider Business Mailing Address
First Line	:	PO BOX 17543
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32245-7543
Country	:	US
Telephone Number	:	904-399-3150
Fax Number	:	904-399-3515

Provider Business Practice Location Address
First Line	:	2820 GIBSON RD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32207-4804
Country	:	US
Telephone Number	:	904-399-3150
Fax Number	:	904-399-3515

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

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	01/05/2010

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