NPIMap

Organization Active NPI

Md2U Florida LLC

  • Gerontology Nurse Practitioner
  • Jacksonville, FL
National Provider Identifier
1235422775
Registry record updated Sep 25, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gerontology Nurse PractitionerTaxonomy code 363LG0600X
Legal business name
MD2U FLORIDA LLC
Practice address
10151 Deerwood Park Blvd
200-250
Jacksonville, FL 32256-0566
Phone
(502) 327-9100
Fax
(502) 742-3767
NPI assigned
May 17, 2011
Last updated
Sep 25, 2012By the provider in NPPES
Organization subpart
Yes
Parent organization
MD2U MANAGEMENT LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 25, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Gregory D. Latta
Title
Cfo/Cio
Phone
(502) 416-1851

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gerontology Nurse Practitioner 363LG0600X Primary

Addresses

Primary practice location

10151 Deerwood Park Blvd
200-250
Jacksonville, FL 32256-0566

Mailing address

PO Box 7219
Louisville, KY 40257-0219
Phone (502) 416-1851

Other identifiers 1

IdentifierTypeStateIssuer
10D2045820OtherFLCLIA - CERTIFICATE OF WAIVER

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1305590400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1348531200000",
    "number": "1235422775",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7219",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402570219",
            "telephone_number": "502-416-1851",
            "fax_number": "502-416-1857"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10151 DEERWOOD PARK BLVD",
            "address_2": "200-250",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322560566",
            "telephone_number": "502-327-9100",
            "fax_number": "502-742-3767"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MD2U FLORIDA LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MD2U MANAGEMENT LLC",
        "enumeration_date": "2011-05-17",
        "last_updated": "2012-09-25",
        "status": "A",
        "authorized_official_last_name": "LATTA",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_middle_name": "D.",
        "authorized_official_title_or_position": "CFO/CIO",
        "authorized_official_telephone_number": "502-416-1851"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA - CERTIFICATE OF WAIVER",
            "identifier": "10D2045820",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.