Basic Information
| Provider Information | |||||||||
| NPI: | 1346811486 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SOLANTIC OF JACKSONVILLE, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 115 EASTPARK DR STE 303 | ||||||||
| Address2: | |||||||||
| City: | BRENTWOOD | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370277548 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6156004074 | ||||||||
| FaxNumber: | 6153093341 | ||||||||
| Practice Location | |||||||||
| Address1: | 1544 COUNTY ROAD 220 STE 100 | ||||||||
| Address2: | |||||||||
| City: | ORANGE PARK | ||||||||
| State: | FL | ||||||||
| PostalCode: | 320034991 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9048309009 | ||||||||
| FaxNumber: | 9048728412 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/09/2021 | ||||||||
| LastUpdateDate: | 07/09/2021 | ||||||||
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| AuthorizedOfficialLastName: | PERALTA | ||||||||
| AuthorizedOfficialFirstName: | ANNA | ||||||||
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| AuthorizedOfficialTitleorPosition: | VP REVENUE ACCOUNTING | ||||||||
| AuthorizedOfficialTelephone: | 6156004072 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 07/09/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QU0200X | Y | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care |
No ID Information.