MD2U FLORIDA LLC NPI 1235422775

NPI Information

NPI: 1235422775
Provider Name: MD2U FLORIDA LLC
Classification: Nurse Practitioner - 363LG0600X
Entity Type: Organization

Specialization: Gerontology

Address:
10151 DEERWOOD PARK BLVD
200-250
JACKSONVILLE, FL
ZIP 32256
Phone: (502) 327-9100
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MD2U FLORIDA LLC is a gerontology nurse practitioner in Jacksonville, FL. MD2U FLORIDA LLC NPI is 1235422775. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

10151 DEERWOOD PARK BLVD
200-250
JACKSONVILLE, FL
ZIP 32256-566
Phone: (502) 327-9100
Fax: (502) 742-3767

The provider's authorized official is Gregory D. Latta .
The authorized official title is Cfo/cio and has the following contact phone number (502) 416-1851.

The enumeration date for this NPI number is 5/17/2011 and was last updated on 9/25/2012.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363LG0600X	Nurse Practitioner	Gerontology			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	10D2045820	OTHER	FLORIDA	CLIA - CERTIFICATE OF WAIVER

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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