Provider Demographics
NPI:1811246390
Name:ST. VINCENT'S HEALTHCARE
Entity type:Organization
Organization Name:ST. VINCENT'S HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-296-5690
Mailing Address - Street 1:1303 WHISPERING OAK LN
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-5097
Mailing Address - Country:US
Mailing Address - Phone:919-251-9706
Mailing Address - Fax:
Practice Address - Street 1:3 SHIRCLIFF WAY STE 714
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204-4786
Practice Address - Country:US
Practice Address - Phone:904-308-2006
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-30
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC214209282N00000X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Single Specialty
No282N00000XHospitalsGeneral Acute Care Hospital