Provider Demographics
NPI:1326017419
Name:NAVAL HOSPITAL JACKSONVILLE
Entity Type:Organization
Organization Name:NAVAL HOSPITAL JACKSONVILLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:STAFF PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:PERELLO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:904-542-7911
Mailing Address - Street 1:1754 RUSTLING DR
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32003-8634
Mailing Address - Country:US
Mailing Address - Phone:904-215-9149
Mailing Address - Fax:
Practice Address - Street 1:2080 CHILD ST
Practice Address - Street 2:NAVAL HOSPITAL JACKSONVILLE- INTERNAL MEDICINE CLINIC
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32214-5005
Practice Address - Country:US
Practice Address - Phone:904-542-7910
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-14
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A 7245286500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes286500000XHospitalsMilitary Hospital