Provider Demographics
NPI:1114910924
Name:NEW HORIZONS: WOMEN'S MEDICAL GROUP, P.A.
Entity Type:Organization
Organization Name:NEW HORIZONS: WOMEN'S MEDICAL GROUP, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-281-0780
Mailing Address - Street 1:3901 UNIVERSITY BLVD S
Mailing Address - Street 2:SUITE 215
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-4377
Mailing Address - Country:US
Mailing Address - Phone:904-296-3200
Mailing Address - Fax:904-296-0069
Practice Address - Street 1:802 PORT WINE LN
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32225-5230
Practice Address - Country:US
Practice Address - Phone:904-220-3725
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL45591OtherBCBS
FL45991Medicare ID - Type Unspecified