Provider Demographics
NPI:1851374896
Name:JACKSONVILLE INSTITUTE OF FAMILY CARE, P.A.
Entity Type:Organization
Organization Name:JACKSONVILLE INSTITUTE OF FAMILY CARE, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HEBER
Authorized Official - Middle Name:J
Authorized Official - Last Name:ROSA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-992-0608
Mailing Address - Street 1:4745 SUTTON PARK CT
Mailing Address - Street 2:SUITE 801
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224-0250
Mailing Address - Country:US
Mailing Address - Phone:904-992-0608
Mailing Address - Fax:904-992-0670
Practice Address - Street 1:4745 SUTTON PARK CT
Practice Address - Street 2:SUITE 801
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32224-0250
Practice Address - Country:US
Practice Address - Phone:904-992-0608
Practice Address - Fax:904-992-0670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-23
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL31346OtherBLUE CROSS BLUE SHIELD