Provider Demographics
NPI:1467036590
Name:KIDNEY CLINIC OF NORTH FLORIDA PLLC
Entity Type:Organization
Organization Name:KIDNEY CLINIC OF NORTH FLORIDA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:GAURAV
Authorized Official - Middle Name:
Authorized Official - Last Name:TANDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-692-1956
Mailing Address - Street 1:1260 BEACH BLVD STE 3-422
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32250-3406
Mailing Address - Country:US
Mailing Address - Phone:904-744-4448
Mailing Address - Fax:904-744-4048
Practice Address - Street 1:6885 BELFORT OAKS PL STE 230
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-6283
Practice Address - Country:US
Practice Address - Phone:904-593-5333
Practice Address - Fax:904-593-5334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-05
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty