Organization
MD2U FLORIDA LLC
Active
Parent organization
MD2U MANAGEMENT LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
MD2U MANAGEMENT LLC
Authorized official
GREGORY D. LATTA (CFO/CIO)
(502) 416-1851
Entity
Organization
Contact information
Practice address
10151 DEERWOOD PARK BLVD, 200-250, JACKSONVILLE, FL 32256-0566
(502) 327-9100
(502) 742-3767
Mailing address
PO BOX 7219, LOUISVILLE, KY 40257-0219
(502) 416-1851
(502) 416-1857
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10D2045820
CLIA - CERTIFICATE OF WAIVER
FL
Enumeration date
05/17/2011
Last updated
09/25/2012
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