MEDICARE: NORTHEAST FLORIDA ENDOCRINE AND DIABETES ASSOCIATES, PA

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	208D00000X	General Practice Physician
2	174400000X	Specialist

General Provider Information

NPI Number	:	1699412932
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHEAST FLORIDA ENDOCRINE AND DIABETES ASSOCIATES, PA

Provider Business Mailing Address
First Line	:	915 W MONROE ST STE 200
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32204-1177
Country	:	US
Telephone Number	:	904-384-2240
Fax Number	:	904-486-2314

Provider Business Practice Location Address
First Line	:	300 SAINT ELIZABETH WAY STE 160
Second Line	:
City	:	ST JOHNS
State	:	FL
Zip	:	32259-1153
Country	:	US
Telephone Number	:	904-384-2240
Fax Number	:	904-486-2314

Authorized Official
Title or Position	:	CREDENTIALS
Name	:	ELENA M ORAVETZ
Credential	:
Telephone Number	:	904-384-2240

Provider Enumeration Date	:	05/18/2022
Last Update Date	:	06/21/2024

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