Provider Demographics
NPI:1609087782
Name:UNIVERSITY OF FLORIDA AT JACKSONVILLE
Entity Type:Organization
Organization Name:UNIVERSITY OF FLORIDA AT JACKSONVILLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LISCENSED PSYCHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:ROSA
Authorized Official - Last Name:TAPIA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:904-633-0760
Mailing Address - Street 1:6026 SAN JOSE BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32217
Mailing Address - Country:US
Mailing Address - Phone:904-633-0760
Mailing Address - Fax:904-633-0751
Practice Address - Street 1:6026 SAN JOSE BLVD.
Practice Address - Street 2:6026
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32217
Practice Address - Country:US
Practice Address - Phone:904-633-0760
Practice Address - Fax:904-633-0751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY4877251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health