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11900 Atlantic Blvd # 1 Jacksonville FL 32225-2920 | |
| (048) 391-0379 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Internal Medicine |
| Location | 11900 Atlantic Blvd # 1, Jacksonville, Florida |
| Authorized Official Name and Position | Angie Martinez (SENIOR CREDENTIALING PROFESSIONAL) |
| Authorized Official Contact | 4074477120 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
6101 Blue Lagoon Dr Ste 200 Miami FL 33126-3168 Ph: (407) 447-7120 | 11900 Atlantic Blvd # 1 Jacksonville FL 32225-2920 Ph: (048) 391-0379 |
| NPI Number | 1861229072 |
|---|---|
| Provider Enumeration Date | 09/19/2024 |
| Last Update Date | 12/10/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861229072 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| 208D00000X | General Practice | (* (Not Available)) | Secondary |
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