| West Jax Skilled Nursing | |
|
100 Cypress Lagoon Ct Ponte Vedra Beach FL 32082-2106 | |
| (904) 783-2405 | |
| (904) 786-4981 |
| Full Name | West Jax Skilled Nursing |
|---|---|
| Speciality | Family Medicine |
| Location | 100 Cypress Lagoon Ct, Ponte Vedra Beach, Florida |
| Authorized Official Name and Position | Michael Victor Sharpe (SUPERVISOR) |
| Authorized Official Contact | 9047832405 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| West Jax Skilled Nursing 100 Cypress Lagoon Ct Ponte Vedra Beach FL 32082-2106 Ph: (904) 783-2405 | West Jax Skilled Nursing 100 Cypress Lagoon Ct Ponte Vedra Beach FL 32082-2106 Ph: (904) 783-2405 |
| NPI Number | 1063898864 |
|---|---|
| Provider Enumeration Date | 08/04/2015 |
| Last Update Date | 08/04/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063898864 | NPI | - | NPPES |
| 620455400 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 1750382669 (Florida) | Primary |
| 207Q00000X | Family Medicine | 1285048280 (Florida) | Secondary |
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