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NPI Code Detail

MEDICARE: HANS CHARLES NELS LINDVALL PA

MEDICARE: HANS CHARLES NELS LINDVALL 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
1363A00000XPhysician AssistantPA9118852FL

General Provider Information

NPI Number : 1790041408
Entity Type Code : Individual
Provider Name (Legal Business Name) : HANS CHARLES NELS LINDVALL PA
Provider Business Mailing Address
First Line : 4205 BELFORT RD STE 4015
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32216-3623
Country : US
Telephone Number : 904-450-6063
Fax Number : 904-539-4091
Provider Business Practice Location Address
First Line : 281 STATE HIGHWAY 20 E
Second Line :
City : FREEPORT
State : FL
Zip : 32439-3929
Country : US
Telephone Number : 850-835-1235
Fax Number : 850-835-4195
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/06/2012
Last Update Date : 10/03/2024

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Directions to “ HANS CHARLES NELS LINDVALL PA” Practice Location

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