| Jacksonville Integrative Health Llc | |
|
13241 Bartram Park Blvd Unit 2501 Jacksonville FL 32258-5218 | |
| (904) 299-6000 | |
| (904) 299-6001 |
| Full Name | Jacksonville Integrative Health Llc |
|---|---|
| Speciality | General Practice |
| Location | 13241 Bartram Park Blvd Unit 2501, Jacksonville, Florida |
| Authorized Official Name and Position | Gabriel Busquets (OWNER) |
| Authorized Official Contact | 9046214222 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jacksonville Integrative Health Llc 13241 Bartram Park Blvd Unit 2501 Jacksonville FL 32258-5218 Ph: (904) 621-4222 | Jacksonville Integrative Health Llc 13241 Bartram Park Blvd Unit 2501 Jacksonville FL 32258-5218 Ph: (904) 299-6000 |
| NPI Number | 1861089062 |
|---|---|
| Provider Enumeration Date | 12/22/2020 |
| Last Update Date | 09/30/2021 |
| Medicare PECOS PAC ID | 4486060522 |
|---|---|
| Medicare Enrollment ID | O20210315002475 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861089062 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| 332B00000X | Durable Medical Equipment & Medical Supplies | (* (Not Available)) | Secondary |
| Provider Name | Miranda L Donohoe |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1396987764 PECOS PAC ID: 8426106519 Enrollment ID: I20090429000307 |
| Provider Name | David Katz |
|---|---|
| Provider Type | Practitioner - Addiction Medicine |
| Provider Identifiers | NPI Number: 1255310108 PECOS PAC ID: 4385803162 Enrollment ID: I20170707001154 |
| Provider Name | Patrick Micahel Nobles |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1184218612 PECOS PAC ID: 6103229034 Enrollment ID: I20210729001020 |
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