Provider Demographics
NPI:1356702401
Name:GUIDEWELL EMERGENCY MEDICINE DOCTORS, LLC
Entity type:Organization
Organization Name:GUIDEWELL EMERGENCY MEDICINE DOCTORS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT OF DEVELOPMENT
Authorized Official - Prefix:
Authorized Official - First Name:SONDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:TUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-905-7654
Mailing Address - Street 1:4800 DEERWOOD CAMPUS PKWY FL DC1004
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32246-8317
Mailing Address - Country:US
Mailing Address - Phone:321-888-2511
Mailing Address - Fax:
Practice Address - Street 1:9580 W COLONIAL DR
Practice Address - Street 2:
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761
Practice Address - Country:US
Practice Address - Phone:904-854-7911
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GUIDEWELL EMERGENCY MEDICIN DOCTOS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-03-17
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL25561261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLIA890AOtherMEDICARE