Organization
IVPS OF JACKSONSONVILLE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENEANE MARIE WAKULA (OFFICE MANAGER)
(772) 546-9591
Entity
Organization
Contact information
Practice address
1050 RIVERSIDE AVE, JACKSONVILLE, FL 32204-4142
(904) 853-1981
Mailing address
8929 SE BRIDGE RD, HOBE SOUND, FL 33455-5312
(772) 546-9591
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
OS7123
FL
Other
Enumeration date
06/09/2016
Last updated
06/09/2016
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