Provider Demographics
NPI:1598057036
Name:NORTHEAST FLORIDA AIDS NETWORK
Entity Type:Organization
Organization Name:NORTHEAST FLORIDA AIDS NETWORK
Other - Org Name:NFAN
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF CASE MANAGEMENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ELLIOT
Authorized Official - Last Name:ESSEX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-356-1612
Mailing Address - Street 1:2715 OAK ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32205-8204
Mailing Address - Country:US
Mailing Address - Phone:904-356-1612
Mailing Address - Fax:904-356-7095
Practice Address - Street 1:2715 OAK ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32205-8204
Practice Address - Country:US
Practice Address - Phone:904-356-1612
Practice Address - Fax:904-356-7095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-03
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000260000Medicaid