Provider Demographics
NPI:1659539641
Name:HARRY BORCHERDING ARNP PA
Entity Type:Organization
Organization Name:HARRY BORCHERDING ARNP PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:BORCHERDING
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:352-514-2595
Mailing Address - Street 1:1401 RIVERPLACE BLVD
Mailing Address - Street 2:#910
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-9069
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1401 RIVERPLACE BLVD
Practice Address - Street 2:#910
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-9069
Practice Address - Country:US
Practice Address - Phone:352-514-2595
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-28
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9235683314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility