NPIMap

Organization Active NPI

Northeast Florida Endocrine & Diabetes Associates, PA

  • Specialist
  • Jacksonville, FL
National Provider Identifier
1265968929
Registry record updated May 2, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
NORTHEAST FLORIDA ENDOCRINE & DIABETES ASSOCIATES, PA
Practice address
11236 Baptist Health Dr
Suite 340
Jacksonville, FL 32218-2980
Phone
(904) 384-2240
Fax
(904) 486-2314
NPI assigned
May 2, 2017
Last updated
May 2, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 2, 2017

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

Authorized official

Name
Mrs. Dena Clay
Title
Office Manager
Phone
(904) 384-2240

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X NU Primary
Primary Podiatric Medicine Podiatrist 213EP1101X NU

Addresses

Primary practice location

11236 Baptist Health Dr
Suite 340
Jacksonville, FL 32218-2980

Mailing address

915 W Monroe St
Suite 200
Jacksonville, FL 32204-1177
Phone (904) 384-2240

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
10D2131146Northeast Florida Endocrine11236 Baptist Health Dr Ste 340, Jacksonville, FL 32218Certificate of waiverMay 22, 2027

National Provider Directory

National Provider Directory
Tax ID family
NE FL Endocrine Diabetes14 organizations share this tax ID, including this one

Other organizations with this tax ID 13

Organizations that report the same tax identification number in the National Provider Directory.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1493683200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1493683200000",
    "number": "1265968929",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "915 W MONROE ST",
            "address_2": "SUITE 200",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322041177",
            "telephone_number": "904-384-2240",
            "fax_number": "904-486-2314"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11236 BAPTIST HEALTH DR",
            "address_2": "SUITE 340",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322182980",
            "telephone_number": "904-384-2240",
            "fax_number": "904-486-2314"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHEAST FLORIDA ENDOCRINE & DIABETES ASSOCIATES, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-05-02",
        "last_updated": "2017-05-02",
        "status": "A",
        "authorized_official_last_name": "CLAY",
        "authorized_official_first_name": "DENA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "904-384-2240",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "213EP1101X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Primary Podiatric Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "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 May 2, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.