Provider Demographics
NPI:1699412932
Name:NORTHEAST FLORIDA ENDOCRINE AND DIABETES ASSOCIATES, PA
Entity Type:Organization
Organization Name:NORTHEAST FLORIDA ENDOCRINE AND DIABETES ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALS
Authorized Official - Prefix:
Authorized Official - First Name:ELENA
Authorized Official - Middle Name:M
Authorized Official - Last Name:ORAVETZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-384-2240
Mailing Address - Street 1:915 W MONROE ST STE 200
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32204-1177
Mailing Address - Country:US
Mailing Address - Phone:904-384-2240
Mailing Address - Fax:904-486-2314
Practice Address - Street 1:300 SAINT ELIZABETH WAY STE 160
Practice Address - Street 2:
Practice Address - City:ST JOHNS
Practice Address - State:FL
Practice Address - Zip Code:32259-1153
Practice Address - Country:US
Practice Address - Phone:904-384-2240
Practice Address - Fax:904-486-2314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-18
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty