Provider Demographics
NPI:1932309739
Name:NORTHEAST FLORIDA AIDS NETWORK
Entity Type:Organization
Organization Name:NORTHEAST FLORIDA AIDS NETWORK
Other - Org Name:NORTHEAST FLORIDA AIDS NETWORK
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:FUCHS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-356-1612
Mailing Address - Street 1:2715 OAK ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32205-8204
Mailing Address - Country:US
Mailing Address - Phone:904-356-1612
Mailing Address - Fax:904-356-7095
Practice Address - Street 1:2715 OAK ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32205-8204
Practice Address - Country:US
Practice Address - Phone:904-356-1612
Practice Address - Fax:904-356-7095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-19
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL689484400Medicaid