Provider Demographics
NPI:1801569181
Name:DISCOVERY HEALTH ZONE
Entity type:Organization
Organization Name:DISCOVERY HEALTH ZONE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:HARDEN
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE PRACTITIONER
Authorized Official - Phone:904-773-4567
Mailing Address - Street 1:7956 DAWSONS CREEK DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32222-4907
Mailing Address - Country:US
Mailing Address - Phone:904-955-7575
Mailing Address - Fax:
Practice Address - Street 1:101 W 48TH ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32208-5232
Practice Address - Country:US
Practice Address - Phone:904-773-4567
Practice Address - Fax:628-200-2178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-01
Last Update Date:2021-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care