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Individual

BRIAN KEITH NORDGREN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PA-C

Contact information

Practice address
4500 SAN PABLO RD S, JACKSONVILLE, FL 32224-1865
(904) 953-2000
Mailing address
MEDICAL CENTER BLVD, WINSTON SALEM, NC 27157-0001
(336) 716-6674
(336) 716-9188

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
0010-06098
NC
363A00000X
Physician Assistant
5601005453
MI
363A00000X
Physician Assistant
Primary
PA9102205
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
122625600
FL
Enumeration date
08/31/2006
Last updated
10/06/2025
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