Provider Demographics
NPI:1760657399
Name:UNIVERSITY OF FLORIDA, JACKSONVILLE
Entity Type:Organization
Organization Name:UNIVERSITY OF FLORIDA, JACKSONVILLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER ENROLLMENT SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:JOYIA
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-244-3660
Mailing Address - Street 1:653-1 W 8TH ST
Mailing Address - Street 2:4TH FLOOR, LRC
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32209-6511
Mailing Address - Country:US
Mailing Address - Phone:904-244-8525
Mailing Address - Fax:
Practice Address - Street 1:653-1 W 8TH ST
Practice Address - Street 2:4TH FLOOR, LRC
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32209-6511
Practice Address - Country:US
Practice Address - Phone:904-244-8525
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-24
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital