Organization
IMPACT 13 MEDICAL, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WIL E GERMAIN MD (OWNER)
(516) 412-1608
Entity
Organization
Contact information
Practice address
10752 DEERWOOD PARK BLVD, SOUTH WATERVIEW II SUITE 100, JACKSONVILLE, FL 32256
(904) 755-1017
(646) 774-0386
Mailing address
10752 DEERWOOD PARK BLVD, SOUTH WATERVIEW II SUITE 100, JACKSONVILLE, FL 32256-8666
(904) 755-1017
(646) 774-0386
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
—
—
2084N0400X
Neurology Physician
Primary
—
—
2084P0804X
Child & Adolescent Psychiatry Physician
—
—
2084P0805X
Geriatric Psychiatry Physician
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
Other
Enumeration date
11/13/2019
Last updated
12/18/2019
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