MEDICARE: LIBANI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	103T00000X	Psychologist
2	104100000X	Social Worker
3	163W00000X	Registered Nurse
4	171000000X	Military Health Care Provider
5	171R00000X	Interpreter
6	202K00000X	Phlebology Physician
7	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1841986882
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIBANI

Provider Business Mailing Address
First Line	:	1907 ATLANTIC BLVD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32207-3405
Country	:	US
Telephone Number	:	904-388-4712
Fax Number	:

Provider Business Practice Location Address
First Line	:	1907 ATLANTIC BLVD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32207-3405
Country	:	US
Telephone Number	:	904-388-4712
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. PAUL BARAKAT
Credential	:
Telephone Number	:	904-962-6005

Provider Enumeration Date	:	04/13/2023
Last Update Date	:	04/13/2023

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Directions to “LIBANI ” Practice Location

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