Provider Demographics
NPI:1851916209
Name:NORTH FLORIDA NEURODIAGNOSTICS, LLC
Entity Type:Organization
Organization Name:NORTH FLORIDA NEURODIAGNOSTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERNESTO
Authorized Official - Middle Name:
Authorized Official - Last Name:ALONSO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:386-288-5311
Mailing Address - Street 1:426 SW COMMERCE DR STE 101
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32025-1506
Mailing Address - Country:US
Mailing Address - Phone:386-288-5311
Mailing Address - Fax:386-288-0058
Practice Address - Street 1:426 SW COMMERCE DR STE 101
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32025-1506
Practice Address - Country:US
Practice Address - Phone:386-288-5311
Practice Address - Fax:386-288-0058
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEUROLOGY CENTER OF NORTH FLORIDA, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-06-11
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical NeurophysiologyGroup - Single Specialty
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
No293D00000XLaboratoriesPhysiological LaboratoryGroup - Single Specialty