Organization
904 HEALTH, INC
Active
Other names
Manager
Organization subpart
No
Provider details
NPI number
Authorized official
WENDY KELLY (OFFICE ADMINISTRATOR)
(563) 650-2158
Entity
Organization
Contact information
Practice address
96040 LOFTON SQUARE CT, YULEE, FL 32097-6347
(904) 659-2475
(904) 453-8600
Mailing address
221 N HOGAN ST STE 118, JACKSONVILLE, FL 32202-4201
(904) 659-2475
(904) 453-8600
Taxonomy
Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
—
—
251K00000X
Public Health or Welfare Agency
—
—
261QH0100X
Health Service Clinic/Center
—
—
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Enumeration date
12/21/2022
Last updated
04/09/2025
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